Case report: clinical manifestation of a rare myeloma associated retinopathy

Aleksandra Kubiliūtė1, Laura Kapitanovaitė1, Indrė Meiliūnienė2, Vilma Jūratė Balčiūnienė2

1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania

2Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania

 Abstract

Aim: Multiple myeloma is a cancerous disease caused by plasma cell proliferation and mainly affects people in their adulthood. Ophthalmic presentation of multiple myeloma is not typical and appropriate tactics of treatment rely on clinical variations. In this case, we discuss retinal involvement in multiple myeloma which was treated with systemic chemotherapy, plasmapheresis and intravitreal injections of anti-VEGF.

Results: A 59-year-old woman with recently diagnosed multiple myeloma underwent ophthalmological examination due to decreased visual acuity. Edema of the optic nerve disc, multiple retinal hemorrhages, cotton-wool spots and Roth spots were seen in both eyes on fundus examination and OCT revealed macular edema in both eyes. Systemic treatment with chemotherapy and two plasmapheresis reduced retinopathy symptoms, although macular edema remained clinically significant. To reduce macular edema by preventing angiogenesis and further hemorrhage formation intravitreal anti-vascular endothelial growth factor bevacizumab was decided to be used.

Conclusions: Evaluation of multiple myeloma patients should be comprehensive in regard to their symptoms and complaints. Despite the rare ocular manifestations, multiple myeloma patients with decreased visual acuity have to be frequently examined by an ophthalmologist and eligible treatment should be selected to control ocular symptoms.

Keywords: multiple myeloma, ocular manifestation, retinopathy, Roth spots.