Light-chain Amyloidosis Mimicking Giant Cell Arteritis in a Bilateral Anterior Ischemic Optic Neuropathy Case

Overview

Journal BMC Ophthalmol

Publisher Biomed Central

Specialty Ophthalmology

Date 2013 Dec 24

PMID 24359546

Citations 6

Authors

Alberto Neri

Pierangela Rubino

Claudio Macaluso

Stefano A Gandolfi

Affiliations

Soon will be listed here.

Abstract

Background: Herein we report a case of bilateral anterior ischemic optic neuropathy (AION) showing histopathologic evidence of AL-amyloidosis of the temporal arteries. It is known that light-chain (AL) amyloidosis may rarely affect the temporal arteries, mimicking giant cell arteritis, while, to our knowledge, the association between AL-amyloidosis and AION was not previously described.

Case Presentation: A 64 year-old woman with AL-amyloidosis secondary to a monoclonal gammopathy of undetermined significance (MGUS) referred to our hospital for acute painless drop of vision due to bilateral AION. Age greater than 50 years, high erythrocyte sedimentation rate (ESR), and bilateral AION were suggestive of giant cell arteritis (GCA). However, a temporal artery biopsy excluded GCA, showing segmental stenosis of the lumen caused by amyloidosis of the artery wall.

Conclusions: The present case shows that AL-amyloidosis may present with AION, high ESR, and temporal artery involvement, mimicking GCA. In patients with monoclonal gammopathies, C-reactive protein may be a more specific index of GCA compared with the ESR. Patient medical history and pathology are crucial for a correct diagnosis.

Citing Articles

Bilateral Progressive Optic Neuropathy in a Patient with Familial Amyloid Polyneuropathy: Amyloid Deposits in the Optic Nerve Head?.

Vela J, Perich S, Bulnes V, Loscos I, Baradad M Neuroophthalmology. 2023; 47(3):164-170.

PMID: 37398503 PMC: 10312026. DOI: 10.1080/01658107.2023.2176890.

Ocular complications of plasma cell dyscrasias.

Singh R, Singhal S, Sinha S, Cho J, Nguyen A, Dhingra L Eur J Ophthalmol. 2023; 33(5):1786-1800.

PMID: 36760117 PMC: 10472748. DOI: 10.1177/11206721231155974.

Clinical and Histopathological Features of Gelsolin Amyloidosis Associated with a Novel Variant p.Glu580Lys.

Potrc M, Volk M, De Rosa M, Pizem J, Teran N, Jaklic H Int J Mol Sci. 2021; 22(3).

PMID: 33499149 PMC: 7865823. DOI: 10.3390/ijms22031084.

Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report.

Augstburger E, Sahel J, Audo I BMC Ophthalmol. 2020; 20(1):59.

PMID: 32085748 PMC: 7035659. DOI: 10.1186/s12886-020-01341-z.

Bilateral Non-arteritic Anterior Ischaemic Optic Neuropathy as the Presentation of Systemic Amyloidosis.

Kanaan M, Lorenzi A, Thampy N, Pandit R, Dayan M Neuroophthalmology. 2018; 41(6):330-334.

PMID: 29344073 PMC: 5764065. DOI: 10.1080/01658107.2017.1328604.

References

Landau K, Winterkorn J, Mailloux L, Vetter W, Napolitano B . 24-hour blood pressure monitoring in patients with anterior ischemic optic neuropathy. Arch Ophthalmol. 1996; 114(5):570-5. DOI: 10.1001/archopht.1996.01100130562012. View

Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B . Al amyloidosis. Orphanet J Rare Dis. 2012; 7:54. PMC: 3495844. DOI: 10.1186/1750-1172-7-54. View

Audemard A, Boutemy J, Galateau-Salle F, Macro M, Bienvenu B . AL amyloidosis with temporal artery involvement simulates giant-cell arteritis. Joint Bone Spine. 2012; 79(2):195-7. DOI: 10.1016/j.jbspin.2011.09.007. View

Hayreh S, Podhajsky P, Zimmerman B . Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 1998; 125(4):509-20. DOI: 10.1016/s0002-9394(99)80192-5. View

Srinivasulu N, Sharma V, Samant R . Monoclonal gammopathies presenting as inflammatory arthritis: uncommon but important--a case series. Int J Rheum Dis. 2012; 15(3):336-9. DOI: 10.1111/j.1756-185X.2012.01727.x. View

Churchill C, Abril A, Krishna M, Callman M, Ginsburg W . Jaw claudication in primary amyloidosis: unusual presentation of a rare disease. J Rheumatol. 2003; 30(10):2283-6. View

Hamidou M, Buzelin F, Rojouan J, Barrier J, Briseau J, Grolleau J . [Temporal artery syndrome in amyloidosis AL associated with myeloma]. Rev Med Interne. 1991; 12(4):306-8. DOI: 10.1016/s0248-8663(05)82870-x. View

Taillan B, Fuzibet J, Vinti H, Pesce A, Dujardin P . AL amyloid deposits in temporal artery mimicking giant cell arteritis. Clin Rheumatol. 1990; 9(2):256. DOI: 10.1007/BF02031981. View

Lafforgue P, Senbel E, Figarella-Branger D, Boucraut J, Horschowsky N, Pellissier J . Systemic amyloidosis AL with temporal artery involvement revealing lymphoplasmacytic malignancy in a man presenting as polymyalgia rheumatica. Ann Rheum Dis. 1993; 52(2):158-60. PMC: 1004998. DOI: 10.1136/ard.52.2.158. View

10.

Rao J, Allen N . Primary systemic amyloidosis masquerading as giant cell arteritis. Case report and review of the literature. Arthritis Rheum. 1993; 36(3):422-5. DOI: 10.1002/art.1780360320. View

11.

Ishikawa Y, Ishii T, Masuda S, Asuwa N, Kiguchi H, Hirai S . Myocardial ischemia due to vascular systemic amyloidosis: a quantitative analysis of autopsy findings on stenosis of the intramural coronary arteries. Pathol Int. 1996; 46(3):189-94. DOI: 10.1111/j.1440-1827.1996.tb03597.x. View

12.

Hayreh S, Zimmerman M, Podhajsky P, Alward W . Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol. 1994; 117(5):603-24. DOI: 10.1016/s0002-9394(14)70067-4. View

13.

Hayreh S . Ischemic optic neuropathy. Prog Retin Eye Res. 2008; 28(1):34-62. DOI: 10.1016/j.preteyeres.2008.11.002. View

14.

Hausfater P, Costedoat-Chalumeau N, Amoura Z, Cacoub P, Papo T, Grateau G . AL cardiac amyloidosis and arterial thromboembolic events. Scand J Rheumatol. 2005; 34(4):315-9. DOI: 10.1080/03009740510015203. View

15.

Hayreh S, Podhajsky P, Zimmerman M . Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica. 1999; 213(2):76-96. DOI: 10.1159/000027399. View