8/14/2023 0 Comments High plasma viscosity symptoms![]() ![]() In response to his hyperviscosity, the patient received three sessions of plasmapheresis, after which the serum viscosity decreased from 10.5–2.2 cP, IgA >5400–684 mg/dl, phosphorus 13.9–4.6 mg/dl, his symptoms resolved, and his retinopathy improved.ĬT scan of the chest without contrast at the time of admission showing a 10.3 cm soft tissue mass centered at the anterior right fourth rib with significant destructive changes of the rib. Such findings raised the concern for HVS, and thus, his serum viscosity was analyzed and returned to be 10.5 centipoise (cP), confirming the diagnosis. In response to the patient’s vision changes, ophthalmology conducted an eye fundus exam which showed significant bilateral venous congestion, perivenular flame hemorrhages, white-centered hemorrhages, and tortuosity, indicating hyperviscosity-related retinopathy. He also underwent a biopsy of his right chest wall mass, which yielded a diagnosis of plasmacytoma. The patient underwent a bone marrow biopsy which revealed 80% bone marrow involvement with monoclonal kappa plasma cells, thus confirming the diagnosis of IgA Kappa MM. Accordingly, his clinical picture triggered further investigations for multiple myeloma (MM), which revealed an M-spike of 8.9 gm/dl on serum protein electrophoresis with IgA >5400 mg/dl, Kappa light chains of 40.5 mg/l and Lambda light chains of 5.2 mg/l suggestive of IgA Kappa MM. Imaging studies were significant for a chest computed tomography (CT) scan that showed a 10 cm homogenous anterior chest wall mass at the right fourth rib with destructive changes ( Figure 1) and multiple lytic lesions in the ribs and axial skeleton. In addition, he was found to have an acute kidney injury with a (Cr. Upon admission, the patient was found to be hypercalcemic (13.0 mg/dl), hyperphsophatemic (13.9 mg/dl), anemic (Hgb 6.2 gm/dl) and thrombocytopenic (platelets 128 × 10(3)/mcl). The patient was found to have a mass in the right chest wall on physical exam, which he reported had been growing for weeks. Plasmapheresis is the treatment of choice for HVS.Ī 51-year-old African American male with no chronic medical conditions presented to the emergency department with progressive fatigue, blurry vision, epistaxis, back pain and a 20-pound weight loss over 6 weeks. HVS classically presents with mucosal bleeding, visual and neurological abnormalities.Īn ophthalmological exam is essential in patients with suspected HVS. ![]() Elevated plasma immunoglobulin levels in multiple myeloma can lead to hyperviscosity syndrome (HVS). ![]()
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