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Kitahara J, Yoshinaga T, Kakihara S, Hirano T, Imai A, Miyahara T, Yazaki M, Sekijima Y, Murata T. Ocular findings in patients with acquired ATTRv amyloidosis following domino liver transplantation. PLoS One 2023; 18:e0291716. [PMID: 37713404 PMCID: PMC10503697 DOI: 10.1371/journal.pone.0291716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To investigate the presence of amyloidosis-related ocular findings in patients who received domino liver transplantation from ATTRv amyloidosis donors. METHODS We reviewed the ocular findings in patients who had previously undergone domino liver transplantation and received ophthalmologic examinations between January 2009 and March 2023. The presence of amyloidosis-related ocular findings was retrospectively assessed by two ophthalmologists. RESULTS During the study period, a total of 7 patients with 14 eyes were examined. All patients were considered as acquired ATTRv amyloidosis. The mean age at the final visit was 64.6±8.4 years (52-75 years), and the mean time since domino liver transplantation was 167.6±76.2 months (69-257 months). The two evaluators' assessments for amyloidosis-related ocular findings were completely identical. No amyloid fibril deposition was observed in the pupil, lens, or vitreous. Five patients (10 eyes) had a Schirmer test result of 5mm or less than 5 mm, and four patients with a total of 8 eyes underwent fluorescein angiography and indocyanine green angiography, and no evidence of retinal amyloid angiopathy was found on fluorescein angiography. However, three patients with 6 eyes showed choroidal amyloid angiopathy on indocyanine green angiography. CONCLUSION While cases of choroidal amyloid angiopathy were observed, serious amyloidosis-related ocular complications such as vitreous opacity or secondary glaucoma did not occur even in the long term after domino liver transplantation.
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Affiliation(s)
- Junya Kitahara
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Tsuneaki Yoshinaga
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Nagano, Japan
- Institute for Biomedical Sciences, Shinshu University, Nagano, Japan
| | - Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Nagano, Japan
- Clinical Laboratory Sciences Division, Shinshu University Graduate School of Medicine, Nagano, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Nagano, Japan
- Institute for Biomedical Sciences, Shinshu University, Nagano, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
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Bouaich K, Dufrane R, Youssfi A, Slim E, Ehongo A. Corneal confocal microscopy and familial amyloidotic polyneuropathy. J Fr Ophtalmol 2019; 43:e81-e84. [PMID: 31870669 DOI: 10.1016/j.jfo.2019.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- K Bouaich
- Ophthalmology Department, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium.
| | - R Dufrane
- Ophthalmology Department, CHU de Grenoble, boulevard de la Chantourne, 38043 Grenoble, France
| | - A Youssfi
- Ophthalmology Department, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
| | - E Slim
- Saint-Joseph University, Damas street, Box 17-5208, Beirut, Lebanon
| | - A Ehongo
- Ophthalmology Department, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
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Leonard-Murali S, Nasser H, Ivanics T, Woodward A. Spontaneous hepatic rupture due to primary amyloidosis. BMJ Case Rep 2019; 12:12/10/e232448. [PMID: 31676504 DOI: 10.1136/bcr-2019-232448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous hepatic rupture is an uncommon cause of haemorrhagic shock and very rarely happens due to amyloidosis. This report describes one such case in which a middle-aged man presented in extremis. He was managed initially with massive transfusion, interventional radiology embolisation and decompressive laparotomy for abdominal compartment syndrome. Subsequent coagulopathy was treated with activated factor VII due to deficient native activity. Serum protein electrophoresis and liver biopsy during his hospital course yielded a diagnosis of amyloidosis, which was treated palliatively with steroids and bortezomib. Despite supportive care, he died 10 days after presentation. This case illustrates the importance of considering an uncommon pathology when a patient presents with a condition in an uncommon way.
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Affiliation(s)
| | - Hassan Nasser
- Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tommy Ivanics
- Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ann Woodward
- Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Martel A, Oberic A, Moulin A, Tieulie N, Hamedani M. [Clinical, radiological, pathological features, treatment and follow-up of periocular and/or orbital amyloidosis: Report of 6 cases and literature review]. J Fr Ophtalmol 2018; 41:492-506. [PMID: 29954616 DOI: 10.1016/j.jfo.2017.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/22/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess demographic, clinical, radiological, pathological features, treatment and follow-up of periocular or/and orbital amyloidosis. PATIENTS AND METHODS We conducted an observational retrospective monocentric study from January 2004 to April 2017 in patients diagnosed with histologically proven periocular or/and orbital amyloidosis. RESULTS Six patients were included (2 females, 4 males). Mean age was 76.8 years (range 66-88 years). Mean time between first ophthalmological symptoms and diagnosis was 27 months (range 11-36 months). The main symptoms were subconjunctival infiltration (6 patients; 100%), periocular pain or discomfort (4 patients; 66.6%) and subconjunctival hemorrhage (1 patient; 16.6%). Clinical findings included ptosis (4 patients; 66.6%), keratitis (3 patients; 50%) leading to corneal perforation in one patient, and proptosis (3 patients; 50%). One-half of the patients showed bilateral involvement. AL amyloidosis was identified on immunohistochemistry in 5 patients (83.3%). One case of B cell marginal zone orbital lymphoma was diagnosed. Systemic work-up was negative for all patients. Treatment consisted of simple monitoring (1 patient; 16.6%), surgical debulking (3 patients; 50%), ptosis surgery (1 patient; 16.6%), eyelid or eyelash malposition surgery (2 patients; 33.3%) and orbital radiation beam therapy (2 patients; 33.3%). Mean follow-up was 14.6 months (range 6-36 months), and no progression nor recurrence were noted. CONCLUSION Periocular or/and orbital amyloidosis is rarely encountered. Diagnosis is based on pathological examination, and immunohistochemistry analysis should always be performed to guide systemic work-up. Orbital lymphoma and multiple myeloma should be ruled out if AL amyloidosis is diagnosed. Progression is slow, and surgery is the mainstay of treatment in symptomatic patients. Long-term multidisciplinary follow-up is advocated.
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Affiliation(s)
- A Martel
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse; Service d'ophtalmologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France.
| | - A Oberic
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse
| | - A Moulin
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse
| | - N Tieulie
- Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06000 Nice, France
| | - M Hamedani
- Hôpital ophtalmique Jules-Gonin, 15, avenue de France, 1004 Lausanne, Suisse
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Shaulov A, Avivi I, Cohen Y, Duek A, Leiba M, Gatt ME. Gastrointestinal perforation in light chain amyloidosis in the era of novel agent therapy - a case series and review of the literature. Amyloid 2018; 25:11-17. [PMID: 29241368 DOI: 10.1080/13506129.2017.1416350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gastrointestinal (GI) perforation is remarkably rare in patients with light chain (AL) amyloidosis and has not yet been reported in patients with AL amyloidosis treated with novel agents. Only 24 cases of GI perforation have previously been reported in the setting of AL amyloidosis of which 15 had available information in English. All 15 did not receive novel agent therapy and six died early after experiencing GI perforation. This study reports the characteristics and outcome of AL patients that developed GI perforation in the era of novel agent treatment. Seven patients were reviewed. In two patients, GI perforation was the presenting symptom of AL amyloidosis, whereas five patients developed GI perforations following initiation of an anti-AL therapy (three after bortezomib-based, 1 after lenalidomide-based and 1 after thalidomide-based therapy). All patients underwent surgery and survived the perforation. Treatment was renewed following surgery in six of seven patients, with no further GI complications. In conclusion, GI perforation in AL amyloidosis is rare and mostly reported after treatment initiation. Urgent surgery appears to be lifesaving and renewal of the anti-AL novel therapy appears to be safe, with no significant risk for re-perforation or GI toxicity. Prognosis in these patients is related to severity of the disease and response to therapy rather than the development of GI perforation.
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Affiliation(s)
- Adir Shaulov
- a Department of Haematology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Irit Avivi
- b Department of Haematology and Bone Marrow Transplantation , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Yael Cohen
- b Department of Haematology and Bone Marrow Transplantation , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Adrian Duek
- c Department of Haematology , Sheba-Tel HaShomer Medical Center , Tel Aviv , Israel
| | - Merav Leiba
- c Department of Haematology , Sheba-Tel HaShomer Medical Center , Tel Aviv , Israel
| | - Moshe E Gatt
- a Department of Haematology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Ocular Manifestations and Therapeutic Options in Patients with Familial Amyloid Polyneuropathy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:282405. [PMID: 26558262 PMCID: PMC4628973 DOI: 10.1155/2015/282405] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE This paper aims to review the morphological and functional characteristics of patients affected by familial amyloid polyneuropathy (FAP), with greater focus on type I and its progression after liver transplantation. We also analyse therapeutic options for the ophthalmic manifestations. METHODS The literature from 2002 through 2015 was reviewed, with a total of 45 articles studied, using the key terms related to amyloidosis and its therapeutic approaches. Information was collated, evaluated, critically assessed, and then summarised in its present form. PATHOPHYSIOLOGY AND TREATMENT: FAP results from mutation of the transthyretin gene, with Val30Met being the most frequent substitution. The symptoms are those typical of a sensorimotor autonomic neuropathy and can be halted with liver transplantation. Nowadays there are new medical therapies that delay the progression of the systemic neuropathy. However, there are still no options to avoid ocular disease. CONCLUSION The main ocular manifestations in patients with FAP type I are amyloid deposition in the vitreous, dry eye, and secondary glaucoma. Despite liver transplantation, eye synthesis of amyloid persists and is associated with progressive ocular manifestations, which require continued ophthalmologic follow-up. New therapeutic strategies are therefore needed, particularly to target the ocular synthesis of the abnormal protein.
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Atteintes oculaires des neuropathies amyloïdes héréditaires liées à la transthyrétine. J Fr Ophtalmol 2013; 36:779-88. [DOI: 10.1016/j.jfo.2013.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/23/2013] [Indexed: 11/22/2022]
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