Author:
Wang Patrick,Kanda Pushpinder,Wang Yao,Bal Manpartap
Abstract
Abstract
Background
Cryoglobulinemia, the presence of serum cryoglobulins which are immunoglobulins or complement components that precipitate at temperatures below 37 °C, commonly present with cutaneous manifestations initially, but are more rarely associated with ocular manifestations. To our knowledge, we report the first case of a patient presenting with sequential central retinal artery occlusion (CRAO) associated with cryoglobulinemia.
Case presentation
A 69-year-old female with a history of indolent B-cell lymphoma associated cryoglobulinemia, treated hepatitis B infection and CRAO in the left eye presented with acute vision loss and diffuse retinal whitening with a cherry red spot in her right eye, suggestive of sequential CRAO. Laboratory studies revealed a cryocrit of 55% (normal < 1%), elevated titres of cryoglobulin IgG at 1.98 g/L and cryoglobulin IgM at 3.78 g/L (normal < 0.3 g/L)9, and elevated kappa free light chain at 283.5 mg/L (normal < 0.06 g/L). Such elevated tires of cryoglobulins in the context of the patient’s CRAO raised suspicion of cryoglobulinemia associated CRAO. The patient was promptly referred to rheumatology and oncology and was admitted for treatment including intravenous methylprednisone, rituximab and bendamustine chemotherapy.
Conclusions
We report a patient with a complex medical history presenting with significant vision loss due to a sequential CRAO likely associated with cryoglobulinemia. Although a direct relationship between cryoglobulinemia and CRAO cannot be confirmed in this case, it highlights the importance of considering cryoglobulinemia in high-risk patients with prior history of hematological malignancy or chronic hepatitis infection.
Publisher
Springer Science and Business Media LLC
Reference12 articles.
1. Doguizi S, Sekeroglu MA, Anayol MA, Yilmazbas P. A rare cause of unilateral central retinal vein occlusion in a young patient: type III mixed cryoglobulinemia. Case Rep Ophthalmol Med. 2016;2016:1949362.
2. Ellis RA. Central retinal artery occlusion associated with cryoglobulinemia. AMA Arch Ophthalmol. 1957;57:327–34.
3. Chebil A, Mammouri R, Abdallah MB, El Matri L. Purtscher-like retinopathy as a rare presentation of cryoglobulinemia. Middle East Afr J Ophthalmol. 2016;23:219–21.
4. Cohen SM, Kokame GT, Gass JD. Paraproteinemias associated with serous detachments of the retinal pigment epithelium and neurosensory retina. Retina. 1996;16:467–73.
5. Varma DD, Cugati S, Lee AW, Chen CS. A review of central retinal artery occlusion: clinical presentation and management. Eye. 2013;27:688–97.