Central retinal vein occlusion in an Army ranger with glucose-6-phosphate dehydrogenase deficiency.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most prevalent human enzyme deficiency, affecting an estimated 400 million people worldwide. G6PD deficiency increases erythrocyte vulnerability to oxidative stress and may precipitate episodes of hemolysis when individuals are exposed to triggering agents. Although central retinal vein occlusion (CRVO) does occur in G6PD-deficient individuals, G6PD-deficient individuals exposed to oxidative stressors have not been previously reported to have an increase in CRVO incidence. This is a case of an Army Ranger who deployed to Afghanistan with unrecognized G6PD deficiency and was placed on primaquine following his return to the United States and subsequently developed CRVO. Primaquine is a well-recognized cause of hemolysis in individuals with G6PD deficiency. Hemolytic anemia may contribute to thrombosis as a result of increased erythrocyte aggregation and erythrocyte-endothelium interaction. This case underscores the continued need for routine G6PD screening and avoidance of known triggers in G6PD-deficient individuals.
Kotwal
Russ S
RS
75th Ranger Regiment, 6420 Dawson Loop, Fort Benning, GA 31905, USA.
Butler
Frank K
FK
Murray
Clinton K
CK
Hill
Guyon J
GJ
Rayfield
John C
JC
Miles
Ethan A
EA
D000328:Adult; D055826:Afghan Campaign 2001-; D000743:Anemia, Hemolytic / Q000150:complications; D000962:Antimalarials / Q000009:adverse effects; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications*; D006801:Humans; D008297:Male; D011319:Primaquine / Q000009:adverse effects; D012170:Retinal Vein Occlusion / Q000209:etiology*; D014481:United States
D000962:Antimalarials; D011319:Primaquine