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Wyttynck A, Raby M, Le Gall F, Dupuy A, Soethoudt M, Fouchard M. [Anterior orbital ischemia secondary to type 1 cryoglobulinemia: A case report and literature review]. Rev Med Interne 2024; 45:239-243. [PMID: 38418361 DOI: 10.1016/j.revmed.2024.02.006] [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: 03/21/2023] [Revised: 12/25/2023] [Accepted: 02/11/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Type 1 cryoglobulinemia is characterized by a large number of clinical signs. The lack of specificity of these signs can make diagnosis difficult. Ocular manifestations are rarely described across medical literature. Only 15 cases of ophthalmological involvement secondary to cryoglobulinaemia have been reported. COMMENT We report the case of a 69-year-old patient with cutaneous type 1 cryoglobulinaemia. He presented with bilateral anterior segment ischemia without retinal involvement with unilateral neovascularisation. Treatment of the B lymphocyte clone with rituximab and bendamustine and plasma exchange were initiated with successfully. Two similar cases describing ischaemic damage to the iris during type 1 cryoglobulinemia have been reported in the literature. CONCLUSION Irial ischaemia should be considered as a potential in type 1 cryoglobulinaemia.
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Affiliation(s)
- A Wyttynck
- Service de médecine interne, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - M Raby
- Service de dermatologie, CHU de Rennes, Rennes, France
| | - F Le Gall
- Service d'anatomie et cytologie pathologiques, CHU de Rennes, Rennes, France
| | - A Dupuy
- Service de dermatologie, CHU de Rennes, Rennes, France
| | - M Soethoudt
- Service d'ophtalmologie, CHU de Rennes, Rennes, France
| | - M Fouchard
- Service de dermatologie, CHU de Rennes, Rennes, France
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Dammacco R, Cimino L, De Simone L, Alessio G, Dammacco F. Ocular manifestations of cryoglobulinemia: a reappraisal. Eye (Lond) 2024; 38:585-593. [PMID: 37813978 PMCID: PMC10858169 DOI: 10.1038/s41433-023-02738-y] [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: 08/03/2022] [Revised: 05/15/2023] [Accepted: 09/08/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND/OBJECTIVES To describe frequency and type of ocular manifestations in patients with cryoglobulinemic vasculitis (CV), as well as management approaches and outcomes. SUBJECTS/METHODS This was a retrospective, observational, cohort study of patients who were diagnosed with CV at a single center and regularly underwent a comprehensive ocular assessment. RESULTS Ophthalmologic manifestations were recorded in 16 patients (28%). The diagnoses included dry eye disease and primary Sjögren syndrome in 5 and 2 patients, respectively; peripheral ulcerative keratitis and anterior scleritis in 1 patient each; hyperviscosity syndrome and hypertensive retinopathy in 2 patients each; and Purtscher- like retinopathy in 3 patients. Twelve patients (75%) were anti-HCV/HCV RNA-positive, 11 of whom achieved a sustained virologic response (SVR) following treatment with interferon-α2b plus ribavirin or direct-acting antivirals. All patients were treated with ocular lubricants. Systemic therapeutic measures, including glucocorticoids, immunosuppressive and biologic agents, induced the disappearance or ≥50% reduction of cryoglobulins and major signs of vasculitis in 11 patients (68.7%). In the remaining 5 patients (31.3%), cryoglobulins and CV manifestations remained unchanged or decreased by <50%. The corresponding ophthalmologic assessment showed a variable degree of improvement in the ocular symptoms in all but 2 patients (87.5%). The best corrected visual acuity following treatment improved in 26 eyes, was unchanged in 3 eyes, and worsened in 3 eyes. CONCLUSIONS Eye involvement is not a rare event in CV patients. A timely diagnosis and the correct employment of the available therapeutic measures may result in a favorable outcome of the ocular and extra-ocular manifestations.
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Affiliation(s)
- Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy.
| | - Luca Cimino
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Neuroscience, University of Bari "Aldo Moro", Medical School, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Bari, Italy
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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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Takkar B, Azad SV, Kumar U, Venkatesh P. Extensive choroidal infarction in a case of mixed essential cryoglobulinaemia in a postpartum female. BMJ Case Rep 2016; 2016:bcr-2016-216513. [PMID: 27637276 DOI: 10.1136/bcr-2016-216513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case of mixed essential cryoglobulinaemia resulting in massive choroidal infarction and irreversible vision loss in a postpartum female is discussed. Cryoglobulinaemia can rarely involve ocular vessels and, in this case, was adjunctive to mild hypertension in causing acute choroidopathy. Although the systemic condition of the patient improved after steroids and immunosuppressive agents, the visual loss was permanent.
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Affiliation(s)
- Brijesh Takkar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shorya Vardhan Azad
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Salah S, Imbeau L, Le Lez ML, Regina S, Lioger B. Scleritis and retinal vasculitis associated with a type II mixed cryoglobulinemia. QJM 2014; 107:585-6. [PMID: 24259719 DOI: 10.1093/qjmed/hct235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Salah
- Department of Ophthalmology, Hopital Bretonneau, University of Tours, 2 Boulevard Tonnelé, 37000 Tours, France
| | - L Imbeau
- Department of Ophthalmology, Hopital Bretonneau, University of Tours, 2 Boulevard Tonnelé, 37000 Tours, France
| | - M L Le Lez
- Department of Ophthalmology, Hopital Bretonneau, University of Tours, 2 Boulevard Tonnelé, 37000 Tours, France
| | - S Regina
- Department of Hematology, Pole Santé Léonard de Vinci, Avenue du Pr Alexandre Minkowski, 37175 Chambray les Tours, France
| | - B Lioger
- Department of Internal Medicine, Hopital Bretonneau, University of Tours, 2 Boulevard Tonnelé, 37000 Tours, France
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Nicholson L, Sobrin L. Anterior uveitis secondary to type II essential cryoglobulinemia. J Ophthalmic Inflamm Infect 2013; 3:56. [PMID: 23883484 PMCID: PMC3725159 DOI: 10.1186/1869-5760-3-56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/22/2013] [Indexed: 12/20/2022] Open
Abstract
Background The purpose of this report is to describe the association of severe anterior uveitis with type II essential cryoglobulinemia. Findings A 40-year-old male with a history of psoriatic arthritis presented with severe anterior uveitis associated with type II essential cryoglobulinemia. His uveitis, refractory to steroid treatments, was well controlled following treatments for cryoglobulinemia. The temporal association between his cryoglobulinemia and uveitis, combined with his improved visual acuity and inflammation after plasmapheresis and rituximab infusions, suggests cryoglobulinemia to be the underlying condition of his uveitis. Conclusions To our best knowledge, this is the first reported case of anterior uveitis secondary to type II essential cryoglobulinemia.
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Affiliation(s)
- Laura Nicholson
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Barbosa-Cobos RE, Recillas-Gispert C, Arellanes-García L. [Ocular manifestations of primary systemic vasculitis]. REUMATOLOGIA CLINICA 2011; 7 Suppl 3:S12-7. [PMID: 22119276 DOI: 10.1016/j.reuma.2011.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 10/05/2011] [Indexed: 10/15/2022]
Abstract
A variety of ophthalmic manifestations can occur in patients who have systemic vasculitides and may be the presenting feature. Ocular involvement is frequently found and can result in significant morbidity, even in blindness. Early diagnosis and treatment may improve visual outcome. The management is challenging and requires a multidisciplinary approach. Treatment of ocular manifestations and systemic disease usually follows the same path. The mainstay of treatment is the use of systemic corticosteroids, usually combined with steroid-sparing immunosuppressive drugs. New, promising, emerging therapies rely on the development of biologic agents, which seem useful in the ocular manifestations of systemic vasculitides.
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Affiliation(s)
- Rosa Elda Barbosa-Cobos
- Servicio de Reumatología, Hospital Juárez de México, Col. Magdalena de Salinas, Delegación GA Madero, México DF, México
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Hinkle DM, Dacey MS, Mandelcorn E, Kalyani P, Mauro J, Bates JH, Soukasian SH, Holland GN, Foster CS, Fraunfelder FT, Davis JL, Fraunfelder FW. Bilateral uveitis associated with fluoroquinolone therapy. Cutan Ocul Toxicol 2011; 31:111-6. [PMID: 21981449 DOI: 10.3109/15569527.2011.617024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Retrospective case series, database study and literature review. Forty case reports are described. OBJECTIVE To report a possible association between fluoroquinolones and uveitis. MATERIALS AND METHODS Spontaneous reports from the National Registry of Drug-Induced Ocular Side effects, World Health Organization, and Food and Drug Administration were collected on uveitis associated with systemic fluoroquinolone therapy. A literature review was performed using keywords "uveitis", "fluoroquinolones", and each individual fluoroquinolone name. Additional case reports were collected from the practices of six uveitis subspecialists and one neuro-ophthalmologist. MAIN OUTCOME MEASURES Data garnered from the reports include the type of fluoroquinolone, age, gender, adverse drug reaction (ADR), dosage, duration of therapy until onset of uveitis, concomitant drugs, systemic disease, dechallenge and rechallenge data. RESULTS A total of 40 case reports of uveitis associated with fluoroquinolones were identified including 12 men, 27 women, and 1 case in which the gender was not specified. The median age was 54 years. Dosage varied between the different fluoroquinolone drugs, with the median dosage within the range recommended in the package insert for each different fluoroquinolone. Median time from beginning of therapy to appearance of the ADR was 13 days (range 0-20 days). Thirteen patients were 60 years or older, and one patient was taking systemic anti-inflammatory steroids. There were five positive dechallenge case reports. DISCUSSION According to World Health Organization criteria, the relationship between fluoroquinolone therapy and uveitis is "possible". Causality assessments are based on the time relationship of drug administration, uveitis development, and dechallenge data. CONCLUSIONS Clinicians should be aware of a possible bilateral fluoroquinolone-associated uveitis, particularly the finding of iris transillumination and pigment dispersion.
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Affiliation(s)
- David M Hinkle
- MERSI, 5, Cambridge Center, 8th Floor, Cambridge, NY 02142, USA.
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