Jornal de Oftalmologia Clínica e Experimental
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Multiple Myeloma Presenting as Unilateral Proptosis: A Case Report

Hamad Mohammed Algamra

Purpose: To report on the clinical, imaging and histopathological characteristics of an orbital mass in a patient presenting with unilateral exophthalmos.
Methods: Imaging studies revealed a lobulated orbital mass situated in the superlateral quadrant of the orbit with adjacent bony erosion of the sphenoid bone. Fine needle aspiration cytology form the orbit suggested lymphoproliferative disorder. The bone marrow showed increased plasma cells and was positive for CD 138 with Lambda light chain restriction. Serum protein electrophoresis showed IgD lambda monoclonal band, the urine was positive for Bence Jones protein. Skeletal survey confirmed multiple osteolytic lesions.
Result: The patient was diagnosed as stage IIIB multiple myeloma with orbital plasmacytoma and transferred under the care of oncologist who started bortizomib based chemotherapy with very good clinical and laboratory response after the second cycle and almost 100% clinical recovery of the eye proptosis.
Conclusion: The diagnosis of multiple myeloma should be borne in mind in cases of unilateral proptosis as early diagnosis and treatment can be vision saving in these patients. This can be established with extensive histopathological and biochemical investigations.