title: Midlife diagnosis of Refsum disease in siblings with retinitis pigmentosa -- the footprint is the clue: a case report.
abstract: BACKGROUND
  Refsum disease is a potentially lethal and disabling condition associated with retinitis pigmentosa in which early treatment can prevent some of the systemic manifestations.
  
  
  METHODS
  We present the cases of two brothers with a diagnosis of retinitis pigmentosa from childhood in whom Refsum disease was subsequently diagnosed midlife, after routine enquiry into hand and feet abnormalities. Subsequent treatment through dietary modification stabilised visual impairment and has prevented development of neurological complications to date.
  
  
  CONCLUSIONS
  It is therefore important to consider the diagnosis of Refsum disease in any patient with autosomal recessive or simplex retinitis pigmentosa, and to enquire about the presence of "unusual" feet or hands in such patients.
authors.affiliation: Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Headley Way, Oxford, UK. hari@doctors.org.uk
authors.forename: Hari
authors.initials: H
authors.lastname: Jayaram
authors.forename: Susan M
authors.initials: SM
authors.lastname: Downes