ABSTRACT. Zellweger syndrome, neonatal adrenoleukodystrophy, and infantile Refsum's disease are genetic disorders characterized by the virtual absence of catalasepositive perosisomes and a general impairment of perosisomal functions. Recent studies in these three disorders have provided morphologic evidence of perosisomal "ghosts" of density 1.10 g / c d that contain membrane proteins but lack a majority of the matrix enzyme activities. We report here the biochemical studies in a female infant with clinical features of infantile Refsum's disease whose liver and fibroblasts contained cytosolic catalase but no catalase-positive peroxisomes. Oxidation of phytanic and pipecolic acids was severely impaired, whereas osidation of very-long-chain fatty acids and dihydrosyacetone phosphate acyltransferase activity were only partially decreased. Immunoblot analysis showed that the three peroxisomal &oxidation enzymes (acyl-CoA oxidase, enoyl-CoA hydratasel3-hydrosyacyl-CoA dehydrogenase, and 3-ketoacyl-CoA thiolase) were detectable in liver tissues. The 3-ketoacyl-CoA thiolase was of the mature form (41 kD). in contrast with other perosisomal disorders with multipl'i enzyme deficiencies. The majority of these peroxisomal enzvme activities were associated with two subcellular membrane vesicle fractions lacking catalase: one had the density of normal peroxisomes (1.17 g/cm"), the other, yet undescribed, a lower density (1.137 g/cm"). This suggests that perosisomes (density = 1.17 g/cm") and structures with lower density (density = 1.137 g/cm") found in this patient's cultured skin fibroblasts, although lacking catalase, contained functional perosisomal enzymes. This distinguishes this disorder from other disorders of perosisome biogenesis. (Pediatr Res 34: 270-276, 1993) Abbreviations n-ALD, neonatal adrenoleukodystrophy @-ketothiolase or thiolase, 3-ketoacyl-CoA thiolase bifunctional enzyme, enoyl-CoA hydratasel3-hydrosyacylCoA dehydrogenase VLCFA, very-long-chain fatty acid DAB, diaminobenzidine DHAP-AT, dihydroxyacetone phosphate acyltransferase