Association between isotretinoin use and central retinal vein occlusion in an adolescent with minor predisposition for thrombotic incidents: a case report

Abstract

Introduction: We report an adolescent boy with minimal pre-existing risk for thromboses who suffered central retinal vein occlusion associated with isotretinoin use for acne. To the best of our knowledge, this is the first well documented case of this association.

Case presentation: An otherwise healthy 17-year-old white man who was treated with systemic isotretinoin for recalcitrant acne was referred with central retinal vein occlusion in one eye. Although a detailed investigation was negative, DNA testing revealed that the patient was a heterozygous carrier of the G20210A mutation of the prothrombin gene. Despite the fact that this particular mutation is thought to represent only a minor risk factor for thromboses, it is probable that isotretinoin treatment greatly increased the risk of a vaso-occlusive incident in this patient.

Conclusion: Isotretinoin use may be associated with sight- and life-threatening thrombotic adverse effects even in young patients with otherwise minimal thrombophilic risk. Physicians should be aware of such potential dangers.

Figure 1

Funduscopic image of the left eye. Fundus photograph of the patient's left eye with optic disc oedema, retinal haemorrhages and engorged, tortuous veins. Photograph taken on the day of presentation.

Figure 2

Visual field of the left eye. Printout of the visual field test of the patient's left eye exhibiting a superior arcuate scotoma. Test performed 2 days after presentation.