Rheumatoid hyperviscosity syndrome: reversibility of microvascular abnormalities after treatment.
OBJECTIVE
To report a case of rheumatoid hyperviscosity syndrome involving both retinal and choroidal circulation that resolved after treatment.


METHODS
Interventional case report.


METHODS
A 58-year-old woman with clinical and serologic evidence of an inflammatory connective tissue disease without any visual complaints was referred for a funduscopic evaluation.


RESULTS
Funduscopic examination revealed marked dilation and beading of the venous system, microaneurysms, and telangiectatic capillary beds in the posterior pole. Fluorescein angiography disclosed delayed choroidal filling, prolonged arteriovenous transit time, and areas of capillary nonperfusion. These findings were accompanied by a severe polyclonal hypergammaglobulinemia and a 10-fold increase in serum viscosity. The ocular findings were reversible after plasmapheresis and steroid treatment.


CONCLUSIONS
Rheumatoid hyperviscosity syndrome can involve both retinal and choroidal circulation. The prominent microvasculopathy is reversible after appropriate treatment.
Rezai
Kourous A
KA
Department of Ophthalmology and Visual Science, University of Chicago, Illinois, USA. karezaei@yahoo.com
Patel
Samir C
SC
Eliott
Dean
D
Becker
Michael A
MA
D000284:Administration, Oral; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications / Q000628:therapy*; D001809:Blood Viscosity; D002829:Choroid / Q000098:blood supply*; D015862:Choroid Diseases / Q000097:blood / Q000209:etiology / Q000628:therapy*; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood / Q000150:complications / Q000628:therapy*; D007262:Infusions, Intravenous; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D011239:Prednisolone / Q000627:therapeutic use; D012164:Retinal Diseases / Q000097:blood / Q000209:etiology / Q000628:therapy*; D012171:Retinal Vessels / Q000473:pathology*; D013577:Syndrome
D005938:Glucocorticoids; D011239:Prednisolone; D008775:Methylprednisolone