Hyperviscosity Retinopathy and Immunogammopathy Maculopahy as New Onset of Multiple Myeloma

The purpose is to report a case of immunogammopathy maculopathy and hyperviscosity retinopathy as the presenting feature of new-onset multiple myeloma (MM) in an otherwise healthy man. A 50-years-old man presented with painless visual changes in both eyes for 2 months. Ocular examination revealed bilateral CRVO-like associated with macular edema (ME) and an inferior serous detachment. Hematologic investigation revealed an increased percentage of plasma cells in the bone marrow, reaching the diagnosis of MM IgM/kappa. Clinical support and chemotherapy effectively improved ocular alterations, despite the residual ME. Injection of triamcinolone was carried out, without any response. Bilateral vision reduction with hyperviscosity syndrome-related retinopathy and immunogammopathy maculopathy was the first manifestation of an underlying systemic and potentially fatal disease. This case highlights the need for diligent and thorough investigations for less common systemic conditions associated with retinal vein occlusions.

Case Report: The Use of Intravenous SMOFlipid Infusion to Treat Severe Asparaginase-Induced Hypertriglyceridemia in Two Pediatric Acute Lymphoblastic Leukemia Patients

Asparaginase-induced hypertriglyceridemia can have a spectrum of clinical presentations, from being asymptomatic to having life-threatening thrombosis or hyperviscosity syndrome. At present, there is no recommendation on routine lipid monitoring during asparaginase-containing treatment phase, nor a standardized guideline on its management. Two cases are presented here to illustrate the effects of concurrent infection on asparaginase-induced hypertriglyceridemia in patients with high-risk ALL and the use of SMOFlipid infusion as a treatment option in an acute situation.

Effect of the combined administration of metoprolol and dihydroquercetin on the rheological properties of blood in spontaneously hypertensive rats (SHRs)

Introduction. Hyperviscosity syndrome plays an important role in the pathogenesis of arterial hypertension and its complications associated with impaired microcirculation in target organs. Therefore, along with the use of antihypertensive drugs, it is important to pay attention to the correction of the hyperviscosity syndrome with means of hemorheological agents.The aim is to study the effect of metoprolol and its combined use with dihydroquercetin (DHQ) on the rheological parameters of blood in rats with spontaneous arterial hypertension.Materials and methods. The experiments were carried out on normotensive male Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs). SHRs of the experimental groups received metoprolol (50 mg/kg) or metoprolol and DHQ (50 mg/kg each) daily intragastrically for 6 weeks in 1 % starch mucus; SHRs of the control group and normotensive rats received 1 % starch mucus according to the same scheme. Systemic blood pressure was registered in awake animals. Blood was sampled from the catheterized right common carotid artery. Blood viscosity, plasma viscosity, hematocrit, erythrocyte aggregation and deformability were studied.Results. Compared with the parameters in normotensive rats, SHRs showed significant increase of blood viscosity, hematocrit, erythrocyte aggregation, and decrease of erythrocyte deformability. The course administration of metoprolol induced to a further increase in blood viscosity at low shear rates (15–45 s–1); plasma viscosity, hematocrit and micro-rheological parameters in rats of this group did not significantly differ from those in the control. With the combined administration of metoprolol and DHQ, blood viscosity at shear rates of 300 and 450 s–1 and erythrocyte aggregation were significantly lower than in the control SHRs.Conclusions. The course administration of metoprolol increases the severity of the hyperviscosity syndrome in SHRs. The use of DHQ together with metoprolol partially eliminates adverse effects of the beta blocker on blood rheology parameters.

Efficacy of plasmapheresis as treatment for bilateral hyperviscosity syndrome related retinopathy in multiple myeloma

Purpose: To report a case of good clinical response to plasmapheresis as therapy for a bilateral hyperviscosity syndrome related retinopathy in a young patient with undiagnosed multiple myeloma (MM). Methods: Case report. Results: A 48-year-old caucasian man, previously diagnosed with monoclonal gammopathy of undetermined significance (MGUS), presented for medical attention for back ache and vision decrease, worst in the left eye. Ophthalmological examination revealed presence of bilateral CRVO-like retinopathy which raised the hypothesis of hyperviscosity syndrome (HVS). After confirmation of MM diagnosis, plasmapheresis were promptly begun. The right eye regained a good visual acuity and an anatomical restoration already notable 5 days from the first plasmapheresis. Conclusions: Fundoscopy lead to diagnosis of HVS, it is therefore advisable in all patients with MM in order to perform plasmapheresis as soon as possible if necessary. In case of atypical CRVO, haematological and inflammatory causes, should be always ruled out.

Hyperviscosity Syndrome in Rheumatoid Arthritis

Hyperviscosity syndrome (HVS) is a life-threatening condition often occurring as a complication of Waldenström macroglobulinemia (WM) but rarely in the context of rheumatic disease. Given its rarity, diagnosis can be delayed, leading to greater morbidity.