Proptosis : A rare presenting feature of multiple myeloma

Dr. Asra SalehaJR3 ophthalmologyIGGMC Nagpur

U/L painless proptosis – varied causes

Multiple myelomamalignancy of reticuloendothelial cells not an uncommon conditionBut orbital involvement rare 

Multiple myeloma presenting as U/L painless proptosis is rare

Case reportA 55-year-old-man presented with painless progressive unilateral right sided proptosis with restricted ocular movements of 60 days duration. He also had history of chronic lower back pain , further examination suggested of localised painless anterior chest swelling .DD

Ocular examination

Right eye

Left eye

Visual acuity 4/60 6/9Pupil RAPD NSRLAnterior segment

proptosis WNL

O/M Restricted in all gazes

WNL

FUNDUS Optic disc edema

WNL

Investigations CBCSERUM CALCIUMKFTXRAY CHESTB SCANCT HEAD AND ORBITLOCAL USG FNACMRI HEAD AND ORBIT

MRI of the orbit showing involvement of the greater wing of the sphenoid along with right orbital extension, involving the lateral rectus muscle and the lateral wall of the orbit as well as a right-sided preseptal soft tissue swelling and thickening

DiagnosisMultiple myeloma with unilateral

orbital metastasis with right sided proptosis and optic neuropathy

Management Injection methyl prednisoloneInjection dexamethasoneInjection lenalidomideLocal therapy for proptosis

Management

Initial presentation 

 Presentation of the right eye after chemo therapy.

Discussion In Multiple myeloma metastasis of the

orbit is a rare, but a serious condition. Involvement of almost every ocular structure has been reported . Most common clinical presentation includes proptosis, redness, pain, diplopia, and decreased vision. Unilateral involvement of one eye is not uncommon. It is argued that myelomatous changes of the orbit are common, even though clinical presentation is extremely rare .

Discussion Solitary extramedullary orbital plasmacytoma

as an initial presenting feature in a multiple myeloma patient has also been reported. In most of the cases reported, CT scan was the imaging modality of choice. Treatment options include systemic chemotherapy and local radiation and often good response to these options is noted . Our case is unique because of its dramatic presentation as seen in the images and quick resolution of the symptoms after a very short duration of chemotherapy