Variables in the ACBD5 Gene Leading to Distinct Phenotypes: A Case Report.

We report the cases of a father and his daughter, the former diagnosed with retinitis pigmentosa (RP) and the latter with early foveal atrophy; while both shared a novel variant of uncertain significance (VUS) in the  gene (variant c.431G>A), they exhibited different clinical profiles and disease manifestations. The father was a 48-year-old man who presented with nyctalopia that had persisted since age seven. He had mild disk pallor, vessel attenuation, retinal pigment epithelium (RPE) changes nasal to the fovea, and few mid-peripheral bone spicules. Sequencing analysis showed that he carried seven VUS in five genes: c.431G>A (p.Gly144Asp), c.296T>C (p.Met99Thr),  c.1852G>A (p.Gly618Ser),  c.280G>A (p.Val94Met), c.8939A>C (p.Asn2980Thr),  c.575C>A (p.Pro192His), and c.1375A>C (p.Thr459Pro). He shared only the gene with his 18-year-old daughter. The daughter had 20/20 visual acuity, but further testing showed foveal atrophy and hyperautofluorescence. Intrafamilial phenotypic heterogeneity was detected in our patients. Studies on the role of hormonal factors leading to phenotypic variability are warranted.