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Open Access 01-12-2018 | Case report

Monoclonal immunoglobulin heavy chain gene rearrangement in Fuchs’ uveitis

Authors: Hisae Nakahara, Toshikatsu Kaburaki, Rie Tanaka, Junko Matsuda, Mitsuko Takamoto, Kazuyoshi Ohtomo, Kimiko Okinaga, Keiko Komae, Jiro Numaga, Yujiro Fujino, Makoto Aihara

Published in: BMC Ophthalmology | Issue 1/2018

Abstract

Background

Fuchs’ uveitis (FU) is occasionarlly complicated with heavy vitreous opacity. We have performed vitrectomy procedures to remove vitreous opacity in affected patients as part of differential diagnosis for primary vitreoretinal lymphoma (PVRL).

Case presentation

We retrospectively reviewed the clinical records of five patients who first visited the Uveitis Clinic of the University of Tokyo Hospital between 2009 and 2013, were diagnosed with FU and underwent a vitrectomy for removal of dense vitreous opacity. All were diagnosed as FU by ocular findings and elevation of Goldmann-Witmer coefficient (GWC) value for the rubella virus (RV) antibody. In examinations of the vitreous body, cytological diagnosis, elevation of IL-10/IL-6 ratio, and the kappa/lambda ratio in flow cytometry findings were negative in all cases, whereas monoclonal immunoglobulin heavy chain (IgH) gene rearrangement was positive in 4 cases and negative in 1 case.

Conclusions

Although monoclonal IgH gene rearrangement is thought to be a reliable biomarker for PVRL, a high percentage of vitreous specimens from our FU patients showed pseudo-positive results. Ophthalmologists must take care regarding possible pseudo-positive findings when performing differential diagnosis between FU and PVRL. Combinations of results of cytological diagnosis, IL-10/IL-6 ratio, kappa/lambda ratio, and IgH gene rearrangement may be necessary for a definitive diagnosis of PVRL and differentiation from FU.

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Title: Monoclonal immunoglobulin heavy chain gene rearrangement in Fuchs’ uveitis
Authors: Hisae Nakahara
Toshikatsu Kaburaki
Rie Tanaka
Junko Matsuda
Mitsuko Takamoto
Kazuyoshi Ohtomo
Kimiko Okinaga
Keiko Komae
Jiro Numaga
Yujiro Fujino
Makoto Aihara
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Ophthalmology / Issue 1/2018
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-018-0740-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Monoclonal immunoglobulin heavy chain gene rearrangement in Fuchs’ uveitis

Abstract

Background

Case presentation

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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