Amyloid Deposits in Temporal Artery Mimicking Temporal Arteritis in a Patient With Multiple Myeloma

Azari, Amir A.; Kanavi, Mozhgan R.; Girgis, D.M.; Saipe, Noah; Potter, Heather D.; Albert, Daniel M.

doi:10.1001/jamaophthalmol.2013.1618

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…The final cases included, representing 32 patients over 50 years of age, are summarized in Table 1. The most common finding (19 cases) in the temporal artery biopsy from these reports was the deposition of eosinophilic material with positive staining for Congo-red, indicating amyloidosis 9–23 . In some cases, the amyloid was not readily apparent on the temporal artery biopsy, and only after a second review with Congo-red staining was the amyloid obvious, 19 and in other cases there were findings suggestive of both GCA and amyloid deposition from multiple myeloma, indicating that the two diagnoses can sometimes co-exist 9,21 .…”

Section: Resultsmentioning

confidence: 92%

Masquerades of Giant Cell Arteritis Evident on Temporal Artery Biopsy

2019

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G iant cell arteritis (GCA) is a systemic vasculitis that affects large-and medium-sized blood vessels in patients over 50 years of age. 1 Patients with GCA typically present with systemic symptoms such as headache, fatigue, fever, jaw claudication, scalp tenderness and vision changes. The gold standard for establishing the diagnosis of GCA is a temporal artery biopsy, which helps confirm the diagnosis and justify long-term corticosteroids in patients who are frequently elderly with significant medical comorbidities and who may experience substantial steroid-related side effects. 2 Signs of GCA seen on temporal artery biopsy include a panarteritis consisting of infiltrates of T-lymphocytes, macrophages, epithelioid histiocytes and multinucleated giant cells, often most pronounced in the media and centered near the internal elastic lamina, with fragmentation of the internal elastic lamina, intimal hyperplasia, and near or complete occlusion of the temporal artery lumen. 2 These signs may be present even after treatment with corticosteroids. 3 Temporal artery biopsy may not only confirm the diagnosis of GCA, but may also identify atypical histopathological signs that suggest another diagnosis. These signs include fibrinoid necrosis, inflammation confined to the adventitia, numerous eosinophils or neutrophils, or abnormal deposits such as amyloid. 4 These atypical signs would not be evident on alternative, non-invasive methods of assessing the superficial temporal artery such as color-duplex ultrasonography or contrast-enhanced, high-resolution magnetic resonance imaging (MRI), which have been suggested as replacements for temporal artery biopsy in typical cases. 5,6 The specificity of ultrasound and high-resolution MRI have been reported to be 78-100% and 73-97%, respectively, for GCA. 5 Given that the necessity of temporal artery biopsy in the diagnosis of GCA has been questioned, 5,7,8 we present three cases of patients who presented with visual and systemic symptoms suggestive of GCA who underwent temporal artery biopsy, which revealed an alternative diagnosis to GCA and dramatically altered the patient's treatment and clinical care.

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Section: Resultsmentioning

confidence: 92%

Masquerades of Giant Cell Arteritis Evident on Temporal Artery Biopsy

2019

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“…Unlike in our case, their patient did not present with an elevated ESR. Other underlying biopsy-proven diseases that have been noted to contain giant cells in patients presenting with suspected GCA include herpes zoster vasculitis and amyloidosis involving the temporal artery (26, 27). While giant cells may be found in the lesion of GCA, in our case the giant cells are not involved in any inflammatory process related to an arteritis and seem to be associated with the process of ossification.…”

Section: Resultsmentioning

confidence: 99%

Metaplastic Ossification of the Temporal Artery with Osteoclast-Like Giant Cells: A Mimicker of Giant Cell (Temporal) Arteritis

Sekulic

Truskinovsky

2017

European Journal of Ophthalmology

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“… 8 Common ocular manifestations of amyloidosis include amyloid deposition in the ocular adnexa, conjunctiva, cornea, trabecular meshwork and/or the vitreous, however retinal and choroidal involvement is rare. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 Histopathological analysis of amyloid deposition in the choroid has been reported in cases of systemic primary amyloidosis. 17 , 18 , 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of a case of amyloidosis-associated chorioretinopathy

Nagura

Inoue

Ching

et al. 2020

American Journal of Ophthalmology Case Reports

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Purpose To describe the findings of long-term follow-up of a case of amyloidosis-associated chorioretinopathy by multimodal imagings, including optical coherence tomography (OCT). Observations A 47-year-old woman who had been diagnosed as having systemic amyloidosis was found to have a best corrected visual acuity of 20/13 in both eyes at the age of 41, which subsequently decreased to 20/100 in the left eye and 20/20 in the right eye at age 47. Visual field examination demonstrated worsening of the central scotoma during the follow-up period. Funduscopic examination revealed bilateral white deposits along the choroidal vessels, which became more pronounced over time, along with diffuse pigmentary changes. The fluorescein angiography and indocyanine green angiography findings were consistent not only with atrophic lesions, but also with amyloid deposition (i.e., staining of the vessels). At the baseline, macula OCT revealed a thick hyporeflective band at the choriocapillaris, however, at the last follow-up, it revealed an absent ellipsoid zone, and bilateral progressive retinal pigment epithelium irregularities in both eyes. Conclusions Patients diagnosed as having amyloidosis-related chorioretinopathy may have maintained visual function at the first detection of retinal amyloid deposition, and a number of years may elapse before the patient manifests visual deterioration.

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Amyloid Deposits in Temporal Artery Mimicking Temporal Arteritis in a Patient With Multiple Myeloma

Cited by 9 publications

References 9 publications

Masquerades of Giant Cell Arteritis Evident on Temporal Artery Biopsy

Masquerades of Giant Cell Arteritis Evident on Temporal Artery Biopsy

Metaplastic Ossification of the Temporal Artery with Osteoclast-Like Giant Cells: A Mimicker of Giant Cell (Temporal) Arteritis

Long-term follow-up of a case of amyloidosis-associated chorioretinopathy

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