Zavoreo Iris, Miljenka-Jelena Jurašić* and Bašić Kes Vanja
Department of Neurology, Sestre Milosrdnice University Hospital, CroatiaFulltext PDF
Monoclonal gammopathies are a heterogeneous group of disorders, ranging from the subclinical Monoclonal Gammopathy (MGUS) to malignant systemic disorders. The majority of these paraproteins are IgG with less than 15% being IgM. In patients with peripheral neuropathy, particularly those with demyelinating neuropathies IgM monoclonal gammopathy are much more common. Optic neuritis is an inflammatory, demyelinating condition that causes acute, usually monocular, visual loss. Optic neuritis is the presenting symptom in 15% to 20% of multiple sclerosis patients, but it can also be a secondary presentation of some other disorders. We will describe the case of 37 year old woman who presented with retrobulbar pain and visual field disturbances of the left eye. Spinal tap revealed oligoclonal bands type 5 suggesting haematological disorder. Serum protein electrophoresis showed IgG kappa paraprotein. After diagnostic workup, diagnosis of subclinical Monoclonal Gammopathy (MGUS) was established. Retrobulbar neuritis was treated with corticosteroid therapy (methylprednisolonum, 1 g) for 3 days with significant regression of pain and visual loss.
Optic neuritis; Visual evoked response; IgG gammopathy; MGUS; Diagnostic workup
Iris Z, Jurašić M-J, Vanja BK. Optic Neuritis as the First Sign of MGUS - Clinical Presentation. Ann Clin Case Rep. 2019; 4: 1646.