| Identifier |
walsh_2022_s2_c3 |
| Title |
Waiting for That ‘Bing' Moment to Get the Diagnosis |
| Creator |
Jenny Hepschke, J. Virdee, Richard Blanch |
| Subject |
giant cell arteritis, Horner's syndrome |
| History |
A 55yo Caucasian female initially presented to her GP with a new onset headaches, scalp tenderness, shoulder arthralgia,; night sweats and loss of appetite. Bloods platelets of 379, ESR 26 and CRP of 4. She was diagnosed with Giant cell arteritis; (GCA) and empirically treated with oral Prednisolone 60mg. Her headaches symptoms persisted and she was referred to the; local hospital. The symptoms were confirmed and additionally she was noted to have a right Horner's syndrome. MRI with; Gadolinium and MRA were reported as normal. She was then referred to our service. We reviewed the history with; headaches which the patient described as new onset pressure pain, mainly over the occiput with cough strain exacerbation; and associated symptoms of jaw claudication, scalp tenderness but no amaurosis fugax. On examination the vision was RE; 6/12 and LE 6/6. There was a right Horner's syndrome. Colour vision was normal, there was no RAPD and both optic discs; were normal clinically and on OCT. There was reduced sensation in the right side of her face (V1,2,3) including diminished; corneal sensation. Bulk, tone and power were normal in upper and lower limbs. A temporal artery was performed and; reported as ‘no active inflammation but degenerative changes of the elastic lamina'. MRI showed small foci of deep white; matter T2 hyperintensities, predominantly involving the frontal lobes possibly due to small vessel ischaemic disease. A; Lumbar puncture was done that showed normal protein, elevated glucose and no evidence of neoplastic cells. The patient; was treated with oral steroids but remained symptomatic. Repeat bloods were then sent including ANA, ANCA, ACE, an; infectious screen including hepatitis and HIV and serum Immunoglobulins. |
| Disease/Diagnosis |
Bing neel syndrome (BNS) as a first presentation of Waldenström's macroglobulinemia (WM) presenting like an atypical; giant cell arteritis (GCA) |
| Date |
2022-02 |
| References |
1. Simon et al. Bing-Neel syndrome, a rare complication of Waldenström macroglobulinemia: analysis of 44 cases and; review of the literature. A study on behalf of the French Innovative Leukemia Organization (FILO). Haematologica; 2015 Dec; 100(12): 1587 - 1594.; 2. Grewal et al. Bing-Neel Syndrome: A Case Report and Systematic Review of Clinical Manifestations, Diagnosis, and; Treatment Options. Clinical Lymphoma and Myeloma. 2009, 9 (6) 462-466.; 3. Castillo & Treon. How we manage Bing Neel Syndrome. British Journal of Haematology, 2019, 187, 277-285. |
| Format |
application/pdf |
| Type |
Text |
| Source |
54th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 2022: Walsh Session II |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2022. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6fmx1pb |
| Contributor Primary |
Jenny L. Hepschke, MBBS, BSc(Med), DM |
| Contributor Secondary |
J Virdee, Richard Blanch |
| Setname |
ehsl_novel_fbw |
| ID |
2100236 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6fmx1pb |
