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First Author: F.Akritidou GREECE
Co Author(s): M. Karafyloglou D. Mpakas V. Antoniou P. Papadopoulou D. Karamanis
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To discuss ocular findings in multiple myeloma and to present a case of multiple myeloma which first manifestation was unilateral optic disc edema.
General Hospital of Kavala - Greece
A 74 years old woman consulted the ophthalmology clinic for evaluation of sudden loss of vision in her left eye. Fundus examination showed optic disc edema. At the moment her BCVA was 3/10 while her BCVA in a previous routine examination, about 10 days before the event, was 7-8/10. The optic nerve head presented blurring of optic margins, a small flame hemorrhage over the nasal part of the optic disc. Macula and the rest of the fundus did not present any alteration. During the following 48 hours her vision was further deteriorated: BCVA OS=1/10, Amsler test (+). Fundoscopy revealed the presence of macular edema which was confirmed by the OCT examination. Past ocular history: Hypermetropia of +5.00D in both eyes. About 15 months ago she had a single but severe episode of hyalitis in her right eye and her vision was seriously deteriorated reaching BCVA OD=1/10. This was considered as an ocular manifestation of toxoplasmosis and she received the corresponding therapy but there was no amelioration no response to that therapy. Also laboratory examinations did not confirm the diagnosis of toxoplasmosis. At present fundus examination revealed the presence of a small, round atrophic lesion at the perimacular upper region.
During the diagnostic process rheumatologic and connective tissue diseases, sarcoidosis, arteriosclerosis and cardiovascular pathology, neurological disorders were considered and excluded after extended clinical evaluation, laboratory and imaging exams. Initial laboratory control: ESR=81mm, IgG=196mg/dl, IgA=740 mg/dl, IgM=16,9 mg/dl, while the rest of the examinations was normal. At that point the diagnosis of multiple myeloma was first taken in consideration. Following laboratory tests supported that diagnosis which was finally confirmed by immunoelectrophoresis and the bone marrow biopsy. For the macular edema an intravitreal injection of anti-VEGF was performed. Three weeks after the injection her BCVA was improved reaching 4-5/10c.c, Amsler test was negative. Fundoscopy revealed a regression of the optic disc edema, the flame hemorrhage was completely absorbed while the macular edema was slightly reduced.
In multiple myeloma, ocular findings may be the initial manifestations of the disease. Optic disc involvement is a rare manifestation of multiple myeloma and it is even more rare to be the first manifestation of this disease. Visual loss is usually caused by direct infiltration or compression of the optic nerve. In this case the exact mechanism of the lesion remains still unknown. Early detection may permit safer and effective treatment. All patients with multiple myeloma should thus undergo thorough ophthalmic examination at the time of initial diagnosis and during follow-up.