Autoimmune retinopathy associated with monoclonal gammopathy of undetermined significance: a case report.
Autoimmune Diseases
/ diagnosis
Autoimmunity
Dark Adaptation
/ physiology
Disease Progression
Electroretinography
Female
Fluorescein Angiography
/ methods
Fundus Oculi
Humans
Middle Aged
Paraproteinemias
/ complications
Retina
/ pathology
Retinal Diseases
/ diagnosis
Tomography, Optical Coherence
/ methods
Visual Fields
/ physiology
Autoimmune retinopathy
Monoclonal gammopathy of undetermined significance
Plasma cell dyscrasias
Journal
BMC ophthalmology
ISSN: 1471-2415
Titre abrégé: BMC Ophthalmol
Pays: England
ID NLM: 100967802
Informations de publication
Date de publication:
16 Apr 2020
16 Apr 2020
Historique:
received:
21
05
2019
accepted:
06
04
2020
entrez:
18
4
2020
pubmed:
18
4
2020
medline:
18
3
2021
Statut:
epublish
Résumé
Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell dyscrasia and precursor to multiple myeloma. It has known ocular manifestations, but has not previously been shown to have an association with autoimmune retinopathy. A 57 year-old female presented with 1 year of progressive, bilateral, peripheral vision loss, photopsias, and nyctalopia. Her fundus examination and extensive ancillary testing were concerning for hereditary versus autoimmune retinopathy. The patient was found to have anti-retinal antibodies against carbonic anhydrase II and enolase proteins with a negative genetic retinal dystrophy panel. Malignancy work-up was negative, but the patient was diagnosed with MGUS, a premalignant condition. The patient was treated with immunosuppressive therapies, with rituximab demonstrating the most robust therapeutic response with respect to patient symptoms and ophthalmic testing. MGUS should be considered as a potential etiology of autoimmune retinopathy in patients without other autoimmune or malignant disease processes. Immunosuppressive therapy may be helpful in limiting disease progression, with rituximab showing efficacy in retinopathy refractory to other agents.
Sections du résumé
BACKGROUND
BACKGROUND
Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell dyscrasia and precursor to multiple myeloma. It has known ocular manifestations, but has not previously been shown to have an association with autoimmune retinopathy.
CASE PRESENTATION
METHODS
A 57 year-old female presented with 1 year of progressive, bilateral, peripheral vision loss, photopsias, and nyctalopia. Her fundus examination and extensive ancillary testing were concerning for hereditary versus autoimmune retinopathy. The patient was found to have anti-retinal antibodies against carbonic anhydrase II and enolase proteins with a negative genetic retinal dystrophy panel. Malignancy work-up was negative, but the patient was diagnosed with MGUS, a premalignant condition. The patient was treated with immunosuppressive therapies, with rituximab demonstrating the most robust therapeutic response with respect to patient symptoms and ophthalmic testing.
CONCLUSIONS
CONCLUSIONS
MGUS should be considered as a potential etiology of autoimmune retinopathy in patients without other autoimmune or malignant disease processes. Immunosuppressive therapy may be helpful in limiting disease progression, with rituximab showing efficacy in retinopathy refractory to other agents.
Identifiants
pubmed: 32299429
doi: 10.1186/s12886-020-01423-y
pii: 10.1186/s12886-020-01423-y
pmc: PMC7160953
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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