1
|
Bergman Z, Mohammed T, Schocket L, Aouchiche R, Johnson MA. Autoimmune retinopathy in a patient with smoldering multiple myeloma: a case report. Doc Ophthalmol 2024:10.1007/s10633-024-09965-y. [PMID: 38363513 DOI: 10.1007/s10633-024-09965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Multiple myeloma (MM) is a plasma cell dyscrasia leading to proliferation of monoclonal plasma cells. Ocular involvement in multiple myeloma is uncommon but can occur. The ocular manifestations of MM may include the cornea, uvea, and retinal vasculature. We present a rare case of autoimmune retinopathy associated with smoldering MM. CASE A 76-year-old female with no significant past medical or ocular history presented with four months of worsening vision, difficulty with night driving, and loss of peripheral vision. Examination was notable for pallor of the optic nerves and vascular attenuation. Visual field testing demonstrated significant and progressive field loss in both eyes. An electroretinogram was extinguished under all conditions. Serum protein electrophoresis showed a significant elevation of IgG with an M-spike, and a subsequent bone marrow biopsy was performed showing 12.5% plasma cells, consistent with the diagnosis of MM. CAR antibody testing was positive for anti-enolase, anti-GAPDH, and anti-Rab6 antibodies, consistent with autoimmune retinopathy. DISCUSSION Autoimmune retinopathy associated with MM is exceedingly rare. Management of this condition is challenging, as treatment of the underlying disease does not often lead to improvement in visual symptoms. Ultimately, visual prognosis is very poor, and both patients and clinicians should be aware of the guarded visual potential. CONCLUSION The association of autoimmune retinopathy with multiple myeloma is rare. It is crucial for physicians to be aware of such manifestations to ensure timely and appropriate diagnosis and management for patients.
Collapse
Affiliation(s)
- Zachary Bergman
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Taariq Mohammed
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA.
| | - Lisa Schocket
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Rachid Aouchiche
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| | - Mary A Johnson
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 Redwood Street, Suite 420, Baltimore, MD, 21201, USA
| |
Collapse
|
2
|
Falloon K, Cohen B, Ananthakrishnan AN, Barnes EL, Bhattacharya A, Colombel JF, Cross RK, Driscoll MS, Fernandez AP, Ha C, Herfarth H, Horst S, Hou J, Husni ME, Kroshinsky D, Kuhn KA, Lowder CY, Martin G, Parikh D, Sayed CJ, Schocket L, Siaton BC, Vedak P, Weisman MH, Rieder F. A United States expert consensus to standardise definitions, follow-up, and treatment targets for extra-intestinal manifestations in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55:1179-1191. [PMID: 35277863 PMCID: PMC10022869 DOI: 10.1111/apt.16853] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS Extra-intestinal manifestations (EIMs) are a common complication of inflammatory bowel diseases (IBD), affecting up to half of the patients. Despite their high prevalence, information on standardised definitions, diagnostic strategies, and treatment targets is limited. METHODS As a starting point for a national EIM study network, an interdisciplinary expert panel of 12 gastroenterologists, 4 rheumatologists, 3 ophthalmologists, 6 dermatologists, and 4 patient representatives was assembled. Modified Delphi consensus methodology was used. Fifty-four candidate items were derived from the literature review and expert opinion focusing on five major EIMs (erythema nodosum, pyoderma gangrenosum, uveitis, peripheral arthritis, and axial arthritis) were rated in three voting rounds. RESULTS For use in a clinical practice setting and as part of the creation of a prospective registry of patients with EIMs, the panel developed definitions for erythema nodosum, pyoderma gangrenosum, uveitis, peripheral arthritis, and axial arthritis; identified the appropriate and optimal subspecialists to diagnose and manage each; provided methods to monitor disease course; offered guidance regarding monitoring intervals; and defined resolution and recurrence. CONCLUSIONS Consensus criteria for appropriate and optimal means of diagnosing and monitoring five EIMs have been developed as a starting point to inform clinical practice and future trial design. Key findings include straightforward diagnostic criteria, guidance regarding who can appropriately and optimally diagnose each, and monitoring options that include patient and physician-reported outcomes. These findings will be used in a national multicenter study network to optimise the management of EIMs.
Collapse
Affiliation(s)
- Katherine Falloon
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Edward L. Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Raymond K. Cross
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Christina Ha
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Sara Horst
- Department of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Hou
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center & Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - M. Elaine Husni
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristine A. Kuhn
- Department of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Careen Y. Lowder
- Cleveland Clinic Foundation Cole Eye Institute, Cleveland, OH, USA
| | - George Martin
- Dr. George Martin Dermatology Associates, Kihei, HI, USA
| | - Deep Parikh
- Department of Ophthalmology New York Eye and Ear Infirmary of Mount Sinai, Department of Ophthalmology, New York University Langone Health, New York, NY, USA
| | | | - Lisa Schocket
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Bernadette C. Siaton
- Division of Rheumatology and Clinical Immunology, University of Maryland, Baltimore, MD, USA
| | - Priyanka Vedak
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
| | - Michael H. Weisman
- Department of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Florian Rieder
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
3
|
Rege A, Cunningham SI, Liu Y, Raje K, Kalarn S, Brooke MJ, Schocket L, Scott S, Shafi A, Toledo L, Saeedi OJ. Noninvasive Assessment of Retinal Blood Flow Using a Novel Handheld Laser Speckle Contrast Imager. Transl Vis Sci Technol 2018; 7:7. [PMID: 30479878 PMCID: PMC6239003 DOI: 10.1167/tvst.7.6.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 09/08/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose We assessed the image quality and reproducibility of blood flow measurements from a novel handheld laser speckle imager in handheld and stabilized use cases. Methods Eleven dilated human subjects were imaged with the XyCAM Handheld Retinal Imager investigational device (XyCAM HRI) in the handheld and stabilized use case in nine consecutive imaging sessions. Subjects then underwent standard color fundus photography using a Topcon TRC 50DX. The vessel-to-background contrast of the XyCAM HRI red-free photo was compared to the fundus photograph, while the coefficient of variation of blood flow measurements in specific arteries and veins also was determined. Results Vessel-to-background contrast was statistically greater in the handheld use case when compared to the standard color fundus photographs (P = 0.01). Estimates of mean blood flow velocity (BFV) were highly correlated between the stabilized and handheld use case (r2 = 0.96). Peak velocity estimates in arteries were significantly higher than those in veins (P < 0.05). Conclusions The XyCAM HRI prototype can acquire fundus photographs with the same or better level of clarity as color fundus photographs, and reproducibly acquire functional blood flow information in the handheld use case. Translational Relevance To our knowledge, this is the first human study of a handheld laser speckle retinal imaging device. Determination of retinal blood flow has applications to ophthalmic and systemic disease and a portable handheld retinal imager that determines blood flow may be widely adopted at the point of care.
Collapse
Affiliation(s)
| | | | - Yusi Liu
- Vasoptic Medical Inc., Baltimore, MD, USA
| | - Karan Raje
- Vasoptic Medical Inc., Baltimore, MD, USA
| | - Sachin Kalarn
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| | | | - Lisa Schocket
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| | - Sunni Scott
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| | - Asifa Shafi
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| | - Luis Toledo
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| |
Collapse
|
4
|
Estrin JT, Schocket L, Kregenow R, Henry DH. A retrospective review of blood transfusions in cancer patients with anemia. Oncologist 1999; 4:318-24. [PMID: 10476543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The factors contributing to blood transfusions in patients with anemia of chronic disease are not well documented in the literature. We analyzed all blood transfusion events within a single oncology practice to determine if certain chemotherapy drugs, cancer types, or other factors necessitated more frequent transfusions. PATIENTS AND METHODS Out of 331 patients receiving chemotherapy, 103 (31%) patients received a blood transfusion in 1995. Each of these charts was reviewed and sorted by diagnosis, treatment medications, and past transfusion and/or treatment history. Hemoglobin levels were obtained for each transfusion received in 1995. RESULTS The average hemoglobin at time of transfusion was 7.9 g/dl. Higher hemoglobin levels at transfusion were observed for patients over the age of 60 and patients who received prior chemotherapy. Lower hemoglobin levels at transfusion were observed for patients receiving Epoetin Alfa and sarcoma patients. The average number of red blood cell (RBC) units transfused in 1995 was 5.1 per patient. More units were given to patients receiving etoposide, while fewer units were given to those receiving ifosfamide. We created a transfusion severity index (TSI) to jointly measure these two variables. CONCLUSION The results of this study identify transfusion needs associated with certain groups of cancer patients and with certain types of chemotherapy drugs.
Collapse
Affiliation(s)
- J T Estrin
- MCP-Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19107, USA
| | | | | | | |
Collapse
|