Cristina P Martins*, Rita Reigota, Sandra D Santos, Diana L Gonçalves and Pedro M Ribeiro
Department of Internal Medicine, Coimbra Hospital and University Center - General Hospital, Coimbra, PortugalFulltext PDF
Hyperviscosity Syndrome (HVS) is an oncologic emergency that results from elevated blood viscosity. Hypergammaglobulinemia is the most common cause of HVS, especially monoclonal conditions involving IgM and rarely by IgG. HVS classically presents with the triad of neurological deficits, visual changes, and mucosal bleeding. Diagnosis is based on history and physical exam
findings, in the setting of a potential causative disease. Eye examination is of particular importance, since it can prompt diagnosis and therefore treatment. HVS requires emergent treatment that consists of supportive therapy, plasmapheresis and control of the underlying cause. Plasmapheresis allows symptom relieve and must be initiated promptly.
We report a patient who presented with low back pain, fatigue, weight loss and that was found to have anemia, hypercalcemia, acute kidney injury, hyperproteinemia and multiple osteolytic lesions, that led to the diagnosis of multiple myeloma, later discovered to be of IgG type. On presentation, she also showed signs of gum bleeding and confusion, leading to diagnosis of HVS, after evidence of retinal hemorrhage on eye examination. Plasmapheresis was initiated, with improvement of HVS,
but the patient died due to febrile neutropenia, after beginning of chemotherapy.
This case report describes a rare condition of HVS associated with IgG Myeloma. It highlights the importance of clinical suspicion to the diagnosis and the need for urgent treatment to control symptoms and prevent complications, since HVS represents an oncologic emergency that can lead to a multitude of organ failures if left undiagnosed and untreated, potentially compromising the
Hyperviscosity syndrome; Multiple myeloma; Plasmapheresis; Case report
Martins CP, Reigota R, Santos SD, Gonçalves DL, Ribeiro PM. Hyperviscosity Syndrome: A Rare Presentation of IgG Multiple Myeloma. Clin Case Rep Int. 2021; 5:1219..