A Case of Multiple Myeloma Relapse Presenting with Proptosis

Multiple myeloma is a plasma cell dyscrasia characterized by neoplastic monoclonal proliferation of plasma cells. In multiple myeloma abnormal plasma cell proliferation is generally confined to the bone marrow; however, 3% of cases may develop extramedullary involvement. Ocular involvement in multiple myeloma is exceptionally rare and if ocular involvement does occur, it typically presents with intraocular manifestations. We report a rare case of metastatic multiple myeloma with right orbital involvement, found to have multiple isolated right medial rectus masses.

Poster 91 A Case of Multiple Myeloma Relapse Presenting with Proptosis Aisha Mumtaz1, Raneem Rajjoub1, Rachid Aouchiche1 1 University of Maryland Medical Center, Baltimore, Maryland, USA Introduction: Multiple myeloma is a plasma cell dyscrasia characterized by neoplastic monoclonal proliferation of plasma cells. In multiple myeloma abnormal plasma cell proliferation is generally confined to the bone marrow; however, 3% of cases may develop extramedullary involvement. Ocular involvement in multiple myeloma is exceptionally rare and if ocular involvement does occur, it typically presents with intraocular manifestations. We report a rare case of metastatic multiple myeloma with right orbital involvement, found to have multiple isolated right medial rectus masses. Description of Case(s): A 70 year-old female with a history of multiple myeloma who presented with a two month history of horizontal binocular diplopia and unilateral proptosis of right eye. There was no previous history of trauma, fevers, or chills. Examination revealed bilateral eyelid retraction, right eye proptosis, and restricted adduction of the right eye. Slit lamp and funduscopic examination were otherwise unremarkable. An MRI of the orbits was obtained which revealed multiple masses involving the medial rectus of the right orbit concerning for metastasis. Laboratory studies showed an elevated kappa free light chain, and an increased kappa/lambda ratio, indicating new disease activity. Notably, testing was negative for thyroid disorders and myasthenia gravis. The patient underwent positron emission tomography (PET), which revealed diffuse metastatic disease involving multiple organ systems. Her chemotherapy regimen was adjusted given evidence of newly discovered metastatic disease. The patient underwent external beam radiation therapy to the right orbit with improvement in her motility deficit. Conclusions, including unique features of the case(s): Our case highlights the rare findings of an ocular presentation of multiple myeloma including medial rectus enlargement and proptosis, which ultimately led to our patient's diagnosis of metastatic disease. Given the rarity of ocular involvement in multiple myeloma, we report this case to help characterize clinical manifestations of orbital multiple myeloma, and to highlight that proptosis can be an important indicator of metastasis and disease recurrence. References: 1. Vatansever M, Bozkurt FM, Dinç E, et al. Orbital Metastasis of Multiple Myeloma: Case Report. Turk J Ophthalmol. 2016;46(3):148-150. doi:10.4274/tjo.73645 2. Knapp AJ, Gartner S, Henkind P. Multiple myeloma and its ocular manifestations. Surv Ophthalmol. 1987;5:343-51 Keywords: Paraneoplastic syndromes, Neuro-ophth & systemic disease (eg. MS, MG, thyroid), Orbit, Tumors, Ocular motility Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Aisha Mumtaz- 443-834-3219 2020 Annual Meeting Syllabus | 145