Treatment of Gastrointestinal Bleeding in a Probable Case of Cerebroretinal Microangiopathy with Calcifications and Cysts

Abstract

Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is a highly pleiotropic disorder, particularly affecting the eye, brain, bone, and gut. The potential catastrophic sequelae of the associated gastrointestinal phenotype, variably characterised by both chronic bleeding and liver failure, is becoming increasingly apparent. Here we report a probable case of CRMCC with pre- and postnatal growth restriction, bilateral exudative retinopathy, a pathognomonic pattern of intracranial calcification, white matter disease, osteopenia with a tendency to fractures, and chronic gastrointestinal bleeding secondary to abnormal dilated vasculature. The gastrointestinal endoscopic findings were characteristic of gastric antral vascular ectasia (GAVE). Treatment with a combination of oral oestrogen and progesterone ameliorated the gastrointestinal blood loss such that monthly blood transfusions could be stopped. The benefit of this relatively benign therapy in managing the potentially life-limiting consequences of an abnormal gastrointestinal vasculature in CRMCC is of great interest.

Fig. 1

Brain MRI performed at age 27 years. A Sagittal T1-weighted scan shows extensive involvement of the basal ganglia consistent with calcification, and a cystic lesion of the left parietal lobe. B T2-weighted axial image demonstrating asymmetric white matter high signal in the left parieto-occipital region, and extensive, asymmetric calcification of the basal ganglia.

Fig. 2

Endoscopy preformed at 22 years of age. Areas of erythema represent vascular ectasia. Within the gastric antrum (image unavailable) the erythematous lesions extend proximally along the length of the stomach to produce a so-called ‘watermelon stomach’.