SHM Converge Scientific Abstract ePoster Gallery-When Altered Blood Viscosity Alters Mental Status

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This case describes a 69-year-old man with diabetes and hypertension who presented with acute encephalopathy after several weeks of cough and diffuse pain. Initial evaluation showed severe anemia, marked hypercalcemia, elevated total protein, and a large destructive chest wall mass concerning for malignancy. Although his calcium normalized quickly with standard therapy, his mental status did not improve, prompting further workup.<br /><br />Subsequent studies revealed findings consistent with multiple myeloma, including a markedly elevated IgA level, an M-spike on SPEP, and an abnormal free kappa/light chain ratio. Because hyperviscosity syndrome (HVS) can cause neurologic symptoms, clinicians considered it as the cause of his persistent altered mental status. Blood viscosity testing, obtained before treatment, was elevated and confirmed the diagnosis.<br /><br />The patient underwent plasmapheresis before bone marrow biopsy results were available. His IgA level fell substantially, and his encephalopathy completely resolved over the following days. He also received dexamethasone and bortezomib, with plans for additional myeloma-directed therapy including daratumumab.<br /><br />The report emphasizes that HVS is an oncologic emergency classically associated with neurologic deficits, visual symptoms, and mucosal bleeding, most often due to IgM paraproteinemia but rarely from IgA. This case is notable because altered mental status was the isolated presenting feature, without obvious bleeding or visual complaints. The authors stress that in the right clinical setting, HVS should remain on the differential diagnosis for encephalopathy, and treatment should not be delayed while awaiting confirmatory testing. Early plasmapheresis can rapidly reverse symptoms and prevent serious complications, but definitive management still requires treatment of the underlying plasma cell disorder.

Asset Subtitle

Troy Holden

Meta Tag

Author List Keerthana Samanthapudi, Nanditha Venkatesan, Shruthi Sethuraman, Siya Bhagat, Troy Holden

Category Clinical Vignettes

Concept Hyperviscosity Syndrome

Concept Total Plasma Exchange

Concept Altered Mental Status

Concept IgA Monoclonal Gammopathy

Concept Neurological Manifestation

Distinguished Non-Finalist

Presenter Organization UPMC Internal Medicine

Presenting Author Troy Holden

Track Adult

Keywords

multiple myeloma

hyperviscosity syndrome

encephalopathy

IgA paraproteinemia

plasmapheresis

M-spike

severe anemia

hypercalcemia

plasma cell disorder

bortezomib

Hyperviscosity Syndrome

Total Plasma Exchange

Altered Mental Status

IgA Monoclonal Gammopathy

Neurological Manifestation