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O’Donovan C, Wu AD, Lim WS. Rare presentation of orbital metastasis in multiple myeloma. Saudi J Ophthalmol 2024; 38:185-187. [PMID: 38988781 PMCID: PMC11232743 DOI: 10.4103/sjopt.sjopt_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 07/12/2024] Open
Abstract
Orbital manifestations are rarely observed in multiple myeloma (MM) and when they occur, they are often the first manifestation. We report a rare occurrence of vision loss in a 51-year-old female from orbital metastases in MM without proptosis or diplopia. The ophthalmic presentation of MM is usually progressive proptosis, pain, diplopia, and visual loss. The presence of metastasis in MM indicates poor prognosis and orbital metastases have worse survival rates. In conclusion, in cases of profound vision loss with no obvious cause, neuroimaging should be performed to evaluate the orbital extent of the disease and exclude intracranial pathology.
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Affiliation(s)
- Charles O’Donovan
- Department of Ophthalmology, Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Angela D. Wu
- Department of Ophthalmology, Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Wei S. Lim
- Department of Ophthalmology, Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
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Singh RB, Singhal S, Sinha S, Cho J, Nguyen AXL, Dhingra LS, Kaur S, Sharma V, Agarwal A. Ocular complications of plasma cell dyscrasias. Eur J Ophthalmol 2023; 33:1786-1800. [PMID: 36760117 PMCID: PMC10472748 DOI: 10.1177/11206721231155974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
Plasma cell dyscrasias are a wide range of severe monoclonal gammopathies caused by pre-malignant or malignant plasma cells that over-secrete an abnormal monoclonal antibody. These disorders are associated with various systemic findings, including ophthalmological disorders. A search of PubMed, EMBASE, Scopus and Cochrane databases was performed in March 2021 to examine evidence pertaining to ocular complications in patients diagnosed with plasma cell dyscrasias. This review outlines the ocular complications associated with smoldering multiple myeloma and monoclonal gammopathy of undetermined significance, plasmacytomas, multiple myeloma, Waldenström's macroglobulinemia, systemic amyloidosis, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes (POEMS) syndrome, and cryoglobulinemia. Although, the pathological mechanisms are not completely elucidated yet, wide-ranging ocular presentations have been identified over the years, evolving both the anterior and posterior segments of the eye. Moreover, the presenting symptoms also help in early diagnosis in asymptomatic patients. Therefore, it is imperative for the treating ophthalmologist and oncologist to maintain a high clinical suspicion for identifying the ophthalmological signs and diagnosing the underlying disease, preventing its progression through efficacious treatment strategies.
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Affiliation(s)
- Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Great Ormond Street Institute of Child Health, University College London, London, UK
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sachi Singhal
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, PA, USA
| | - Shruti Sinha
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Junsang Cho
- Department of Ophthalmology, Vanderbilt Eye Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Snimarjot Kaur
- Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT, USA
| | - Vasudha Sharma
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, University of Maastricht, Maastricht, the Netherlands
- Department of Ophthalmology, The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Krečak I, Ruščić I, Zlatović JJ, Šupe M, Krečak MV, Gverić-Krečak V. Paraneoplastic aortitis in a patient with relapsed multiple myeloma successfully treated with daratumumab, bortezomib and dexamethasone. Ann Hematol 2021; 100:1623-1624. [PMID: 33404692 DOI: 10.1007/s00277-020-04369-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Ivan Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Stjepana Radića 83, 22000, Šibenik, Croatia.
| | | | - Josipa Jović Zlatović
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Stjepana Radića 83, 22000, Šibenik, Croatia
| | - Marijana Šupe
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Stjepana Radića 83, 22000, Šibenik, Croatia
| | | | - Velka Gverić-Krečak
- Department of Internal Medicine, General Hospital of Šibenik-Knin County, Stjepana Radića 83, 22000, Šibenik, Croatia
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Osório RM, Pina S, Salero T, Coelho MV, Sousa D, Mendonça C. Association of Multiple Myeloma and Giant Cell Arteritis - A Case Report. Eur J Case Rep Intern Med 2020; 7:001360. [PMID: 32015971 PMCID: PMC6993903 DOI: 10.12890/2020_001360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 11/24/2022] Open
Abstract
Autoimmune diseases (AID) have been associated with a variety of lymphoproliferative disorders. Multiple myeloma (MM), one of the most common haematologic malignancies characterized by clonal proliferation of bone marrow plasma cells, has been associated with a range of autoimmune disorders. In this report, we described a case study of a patient admitted to our Internal Medicine Department for a bone marrow biopsy and myelogram due to a monoclonal peak observed by his general practitioner. However, at admission he presented typical giant cell arteritis (GCA) complaints, suggesting the coexistence of both diseases. The possible pathogenesis, as found in the literature, explaining the association will be discussed.
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Affiliation(s)
- Rui Marques Osório
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal
| | - Sérgio Pina
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal
| | - Teresa Salero
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal
| | - Margarida Viana Coelho
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal
| | - Domingos Sousa
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal
| | - Catarina Mendonça
- Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal
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Two different causes in a patient with distal symmetric axonal polyneuropathy: Churg-Strauss syndrome and multiple myeloma, coincidental or associated with each other? Neurol Sci 2017; 38:1343-1344. [PMID: 28332041 DOI: 10.1007/s10072-017-2927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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Shimanovsky A, Alvarez Argote J, Murali S, Dasanu CA. Autoimmune manifestations in patients with multiple myeloma and monoclonal gammopathy of undetermined significance. BBA CLINICAL 2016; 6:12-8. [PMID: 27331023 PMCID: PMC4900299 DOI: 10.1016/j.bbacli.2016.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 12/20/2022]
Abstract
Background Multiple myeloma (MM) and its precursor, monoclonal gammopathy of undetermined significance (MGUS), have been linked with several autoimmune conditions in the medical literature. Yet, significance of these associations is not well understood. Methods Herein, we provide a comprehensive literature review on autoimmune disorders identified in patients with MM and MGUS. Most relevant papers were identified via searching the PubMed/Medline and EMBASE databases for articles published from inception until May 1, 2016. Findings Scientific literature on autoimmune conditions in patients with MM and MGUS consists of several case series and a multitude of case reports. Our analysis suggests an increased prevalence of autoimmune conditions in patients with MM and monoclonal gammopathy of undetermined significance (MGUS), including various autoimmune hematologic and rheumatologic conditions among other entities. Conversely, persons with various autoimmune conditions tend to have a higher prevalence of MGUS and MM than the general population. Conclusions Future research is required to explore further the link between MGUS/MM and autoimmune disorders. Inflammation in the setting of autoimmunity may serve as a trigger for MGUS and MM. In addition, a common genetic susceptibility for developing both an autoimmune disease and MM/MGUS might also exist. Autoimmune hematologic and rheumatologic diseases may pose important clinical problems for the MM patients. Therefore, a catalogue of these problems is important so that physicians are able to consider, identify and address them promptly. A comprehensive review linking MM and MGUS with autoimmune disorders There is increased prevalence of autoimmune conditions in patients with MM and MGUS Most autoimmune disorders precede the development of plasma cell dyscrasias
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Affiliation(s)
- Alexei Shimanovsky
- Department of Hematology and Oncology, University of Connecticut Health Science Center, Farmington, CT, USA
| | - Juliana Alvarez Argote
- Department of Medicine, University of Connecticut Health Science Center, Farmington, CT, USA
| | - Shruti Murali
- Department of Medicine, University of Connecticut Health Science Center, Farmington, CT, USA
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Lim LT, Ramamurthi S, Collins CE, Mantry S. Peripheral Ulcerative Keratitis Associated with Multiple Myeloma. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n12p550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Lik Thai Lim
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | | | - Cian E Collins
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Sanjay Mantry
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
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Burnside NJ, Alberta L, Robinson-Bostom L, Bostom A. Type III hyperlipoproteinemia with xanthomas and multiple myeloma. J Am Acad Dermatol 2006; 53:S281-4. [PMID: 16227109 DOI: 10.1016/j.jaad.2005.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 03/25/2005] [Accepted: 04/01/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND Type III hyperlipoproteinemia usually results from an inherited defect in the composition of apolipoprotein E and is associated with atherosclerosis. An acquired form of the type III phenotype may rarely be associated with myeloma and immunoglobulin-lipoprotein complexes. OBSERVATION We present the case of a 72-year-old man with a history of well-controlled, unclassified hypercholesterolemia and hypertriglyceridemia, without evidence of atherosclerotic disease. He subsequently developed refractory dyslipidemia, palmar crease, and tuberous xanthomas. Type III hyperlipoproteinemia was confirmed, and nonclassic defective apolipoprotein E. Common secondary causes of hyperlipidemia were ruled out. A workup for malignancy revealed monoclonal IgA gammopathy. Immunostaining confirmed IgA antibodies complexed to the patient's very low-density lipoprotein (VLDL) fraction, causing gross impairment of VLDL metabolism. Conventional therapy for type III hyperlipoproteinemia was attempted but ineffective. Thus, chemotherapy was initiated for his myeloma, with subsequent lowering of his IgA, cholesterol, and triglyceride levels, and improvement of his xanthomas. CONCLUSION There are several unusual features to this case. Planar xanthomas can be associated with myelomas, but usually in the setting of normal lipids. Type III hyperlipoproteinemias are not usually refractory to standard therapy and are only rarely associated with IgA myeloma. IgA antibodies complexed to the patient's VLDL caused gross impairment of VLDL metabolism. The patient's apolipoprotein E genotype (heterozygote E2/E3) is not typical for expression of the heritable type III phenotype (homozygote E2/E2). These features support a causal relationship between this patient's multiple myeloma and type III hyperlipoproteinemia rather than two independent, coexistent conditions.
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Affiliation(s)
- Nancy J Burnside
- Department of Dermatology, Brown Medical School, Providence, Rhode Island 02903, USA
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Schlegel A. 25-year follow-up of a case of giant cell aortitis. Am J Med 2004; 117:625. [PMID: 15465520 DOI: 10.1016/j.amjmed.2004.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mozaffari E, Mupparapu M, Otis L. Undiagnosed multiple myeloma causing extensive dental bleeding: report of a case and review. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:448-53. [PMID: 12374918 DOI: 10.1067/moe.2002.125201] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A case of multiple myeloma causing profuse bleeding during a minor dental surgical procedure is presented. The value of dental radiography in detection of bone changes associated with an undiagnosed case of multiple myeloma is highlighted. We show that the extensive bleeding during the dental procedure could have been prevented if the panoramic radiograph had been evaluated carefully before initiation of the treatment. In addition, we briefly discuss the etiologic factors responsible for the formation of hemostatic abnormalities in multiple myeloma and the value of imaging methods used in diagnostic assessment of the disease.
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Affiliation(s)
- Eisa Mozaffari
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, Philadelphia, 19104, USA.
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