FRI105 Getting Fam-iliar With Familial Chylomicronemia Syndrome: A Case Report

Abstract

Abstract Background: Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive lipid disorder of chylomicron metabolism causing severe hypertriglyceridemia that affects ∼1/1,000,000 individuals. Case Presentation: A 36-year-old male with a history of severely elevated triglyceride levels, recurrent pancreatitis, and biopsy-proven focal segmental glomerulosclerosis presented with severely elevated triglycerides. His initial acute pancreatitis episode was at 30 years old and attributed to alcohol intake. Triglyceride levels were not obtained at the time. He abstained from alcohol; however, his follow up triglyceride level was elevated (5,005 mg/dL, n=35-160 mg/dL) which normalized on an insulin infusion. He started fenofibrate and fish oil. After several additional hospital admissions for either pancreatitis or asymptomatic hypertriglyceridemia with a peak triglyceride level of 14,385 mg/dL, he committed to a low fat and vegan diet. Generic fish oil was transitioned to icosapent ethyl, and he was additionally started on niacin and atorvastatin. Even after following a strict diet and medication adherence, he continued having multiple admissions for acute pancreatitis, most recently complicated by dialysis dependent acute kidney injury in the setting of necrotizing pancreatitis. He has no known history of hypertriglyceridemia in his family. Due to persistent and severe hypertriglyceridemia despite conventional treatment, we suspected an underlying genetic cause, such as FCS. FCS should be suspected in those with recurrent pancreatitis, lipemia retinalis, and/or milky colored blood specimens. Eruptive xanthomas may also be present. Our patient did not have evidence of eruptive xanthomas on physical examination, but ophthalmology evaluation did show lipemia retinalis. The most common genetic pathologic variant in FCS is in the lipoprotein lipase-1 gene (LPL) that codes for an enzyme which assists in the lipolysis of plasma triglycerides (TG) in chylomicrons. Other common genes associated with severe hypertriglyceridemia are APOC2, APOAV, LMF-1, and GPIHBP-1. The mainstay of treatment for FCS are medications to reduce triglyceride levels and a significantly low-fat diet below 25 grams daily. Medium chain triglycerides can be utilized as they do not require enzymes to break down. Otherwise, there are currently no FDA-available therapies specifically targeted for use in those with FCS. Conclusions: This case demonstrates the unfortunate outcome of familial chylomicronemia syndrome despite concerted efforts to reduce triglyceride levels and eliminate additional risk factors. Presentation: Friday, June 16, 2023