Light-chain amyloidosis mimicking giant cell arteritis in a bilateral anterior ischemic optic neuropathy case

BMC Ophthalmology
Alberto NeriStefano A Gandolfi

Abstract

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. 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. 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.

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Citations

Jul 22, 2014·Headache·Jonathan H Smith, Jerry W Swanson
Oct 25, 2014·Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Für Klinische Und Experimentelle Ophthalmologie·Frederick A JakobiecMichael Yoon
May 4, 2017·Romanian Journal of Internal Medicine = Revue Roumaine De Médecine Interne·Valer Mihai PompilianMihaela Antohe
Aug 25, 2016·Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society·Rosanna A M GhinaiSally E Moore
Oct 27, 2017·Retina·Margaret M ReynoldsJose S Pulido
Aug 14, 2020·Modern Rheumatology Case Reports·Azin AzarfarKelli King-Morris
Jan 28, 2021·The New England Journal of Medicine·Sebastian H UnizonySam Sadigh
Jan 28, 2021·International Journal of Molecular Sciences·Maja PotrčAna Fakin
Apr 13, 2021·Journal of the Neurological Sciences·B K Chwalisz
May 28, 2019·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Jonathan A MicieliJason H Peragallo

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Methods Mentioned

BETA
biopsy
ESR

Software Mentioned

eRare RHORCOD

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