SHM Converge Scientific Abstract ePoster Gallery-A Rare Rheumatoid Ramification: Hyperviscosity Syndrome

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This case report describes a rare complication of rheumatoid arthritis (RA): hyperviscosity syndrome (HVS), a hematologic emergency caused by excessive serum proteins or cellular components that impair blood flow and tissue perfusion. HVS can present with mucosal bleeding, visual disturbances, and neurologic symptoms and is more commonly associated with hematologic cancers, but can also occur in chronic inflammatory diseases such as RA.<br /><br />A 31-year-old man with RA and bilateral sensorineural hearing loss presented with hyponatremia, anemia, metabolic acidosis, and multiple signs concerning for HVS, including blurry vision, vertigo, paresthesias, and hearing loss. He had recently been diagnosed with central retinal vein occlusion (CRVO) after developing blurry vision. Workup showed markedly elevated inflammatory and autoimmune markers, including very high rheumatoid factor, elevated anti-CCP, high IgG, and low complement levels. Serum viscosity was significantly elevated at 12 cP, and serum protein electrophoresis revealed a paraprotein. Bone marrow biopsy, skeletal survey, and lumbar puncture were unremarkable, making malignancy less likely.<br /><br />The team concluded that the HVS was likely due to overproduction of rheumatoid factor. He was treated with high-dose IV methylprednisolone for 3 days and four sessions of plasmapheresis, which led to symptomatic improvement.<br /><br />The report emphasizes that RA-associated HVS is rare but serious, often presenting with neurologic, bleeding, cardiac, or constitutional symptoms. It highlights the need for prompt recognition and treatment by hospitalists and other clinicians. Acute management requires plasmapheresis, while longer-term control depends on adequate immunosuppressive treatment of RA to prevent recurrence, even in patients without symptoms.

Asset Subtitle

Dina Nashed

Meta Tag

Author List Dina Nashed, Elizabeth Nettleton, Jinal Patel, Sonali Khandelwal

Category Clinical Vignettes

Concept Hyperviscosity Syndrome

Concept Total Plasma Exchange

Concept Mucosal Bleeding

Concept Visual Changes

Concept Neurologic Findings

Distinguished Non-Finalist

Presenter Organization Rush University Medical Center

Presenting Author Dina Nashed

Track Adult

Keywords

rheumatoid arthritis

hyperviscosity syndrome

plasmapheresis

rheumatoid factor

central retinal vein occlusion

sensorineural hearing loss

serum viscosity

paraprotein

methylprednisolone

autoimmune inflammation

Hyperviscosity Syndrome

Total Plasma Exchange

Mucosal Bleeding

Visual Changes

Neurologic Findings