Hyperviscosity syndrome complicating immunoglobulin G myeloma—Cognisance of early plasmapheresis is crucial
Vivek Sood, Mishra Kundan, Rajat Bahl, Singhal Gaurav, Pavitra Manu Dogra, Pramanik Suman, Vishal Singh
Abstract
Hyperviscosity syndrome (HVS) is an infrequent but life-threatening complication of multiple myeloma (MM) and classically presents with the triad of mucosal bleed, neurological, and visual disturbances. HVS is typically associated with immunoglobulin M (IgM) MM and very rarely may complicate immunoglobulin G (IgG) MM. Even suspicion of HVS necessitates therapy based on clinical severity rather than the calculated degree of viscosity. While plasmapheresis promptly decreases serum viscosity by 30% to 50%, early initiation of anti-myeloma therapy is crucial to prevent rebound phenomena. In this context, we report a case of IgG MM, which despite being complicated by HVS had gratifying outcome attributable to early clinical suspicion and consequent prompt therapeutic intervention.