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   Table of Contents      
ARTICLES
Year : 1980  |  Volume : 28  |  Issue : 1  |  Page : 17-18

Proptosis : A presenting feature of multiple myeloma


1 Department of Medicine, Medical College, Amritsar, India
2 Department of Ophthalmology, Medical College, Amritsar, India

Correspondence Address:
Tejpal Singh
Lecturer in Medicine, Medical College, Amritsar
India
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Source of Support: None, Conflict of Interest: None


PMID: 7203591

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How to cite this article:
Singh T, Datta A K, Chadha M R, Mittar PP. Proptosis : A presenting feature of multiple myeloma. Indian J Ophthalmol 1980;28:17-8

How to cite this URL:
Singh T, Datta A K, Chadha M R, Mittar PP. Proptosis : A presenting feature of multiple myeloma. Indian J Ophthalmol [serial online] 1980 [cited 2020 Oct 21];28:17-8. Available from: https://www.ijo.in/text.asp?1980/28/1/17/31040

Multiple myeloma, a disease allied to malignancy of reticuloendothelial cells is not an uncommon condition. However, the diagno­sis is often made quite late since the disease has multiple modes of presentation[4]. Since orbital involvement is rare in multiple myeloma[6], we report a case who presented with unilateral protosis with complete loss of vision.


  Case report Top


H.S. 45 years male, presented with propto­sis, pain and loss of vision involving the right eye, for the last four months. He had fracture of right clavicle one month back. There were anorexia, loss of weight and mild cough with mucoid expectoration, without fever or pain. On examination, the patient was emaciated, anaemic and had forward and outward protru­sion of the right eye ball with complete restric­tion of its movements and loss of vision. There were three cystic swellings on the right side of the head in the temporal and parietal regions [Figure - 1]. The one in the temporal regions was cystic and pulsatile. Liver was enlarged by two cms. Bony tenderness was present on involved region. Haemoglobin was 10.6 g%, total leucocyte count was 8600/cmm with a differential of 65% neutrophils, 30% lympho­cytes, 2% monocytes and 3% eosinophils with no myeloma cells in the peripheral smear. ESR was 47 mm 1st hour (Westergren). Bence-Jones proteins was absent in urine. Serum proteins were 8.2g% with albumin 4.9% and globulin 3.3g%. Blood urea and Blood sugar were normal. Serum calcium, phosphorus and alkaline phosphatase were 13.2mg%, 4.Omg% and 7.2 Bodansky unit respectively. Serum bilirubin was 0.3mg%. Thymol turbi­dity and flocculation and cephalin cholesterol flocculation & ECG were normal. X-ray skull, [Figure - 2],[Figure - 3] showed multiple punched out cystic areas and X-ray orbits revealed erosion of lesser wing of sphenoid on the right side [Figure - 2]. Bone marrow biopsy revealed myeloma cells and was diagnostic of multiple myeloma. The patient initially improved with melphalan (P-di (2-chloroethyl) amino-L­Phenylalanine) under trade name of Alkeran (Burroughs Wellcome) was given 2 mg/day orally with prednisolone 40 mg/day for one month. After this melphalan was reduced to l mg/day. Patient's general condition, proptosis, pain improved. However he expired after 5 months of therapy.


  Discussion Top


Multiple myeloma commonly presents with bony aches, bony tumours and anaemia, although it can involve the various of organs of the body. Ophthalmic involvement in multiple myeloma may affect the cornea, conjunctiva, uvea, retina, or extra ocular affecting the soft tissues or the adjacent bones and the latter may frequently cause proptosis. The orbital myeloma is rare and its incidence amongst orbital tumours is 0.25% (Rodman[5]). Clarks[3] collected 13 cases of multiple myeloma involv­ing the orbit from 1906 to 1953 from literature and added one of his own. Rodman and Fonts could find only 27 cases of orbital involvement in the literature and described three of their own. In 23 cases, out of 30 cases, the initial manifestation was proptosis. From India, Bamrah et all reported a case with unilateral exophthalmos and Chohan et ale described one case with bilateral involvement. The patient reported by us presented with proptosis, blindness and complete ophthalmoplegia and was initially admitted in Eye department. The spontaneous fracture of clavicle and typical radiological findings aroused suspicion of multiple myeloma and bone marrow biopsy confirmed the diagnosis.


  Summary Top


A case of multiple myeloma presenting with proptosis, complete loss of vision and ophthalmoplegia is described.

 
  References Top

1.
Bamrah, V.S., Khattri, H.N. and Saigal, S. 1963. J, Assoc. of Physicians. India, 17: 621.  Back to cited text no. 1
    
2.
Chohan, B.S., Parmar I.P.S., Chug T.D. and Jain, A.L., 1971, Ind. J. Ophthalmol. 19:177.  Back to cited text no. 2
    
3.
Clarks, E., 1953, Brit. J. Ophthalmol, 37:543.  Back to cited text no. 3
    
4.
Durant, J.R. Barry, W.E. and Learner, N., 1966, Lancet, 1:119.  Back to cited text no. 4
    
5.
Rodman H.I, Font, R.L., 1972, Arch. Opht­halmol., 87:30.  Back to cited text no. 5
    
6.
Wintrobe, M.M., 1974, Clinical Hematology, 7th edition, Lea, Philadalphia.  Back to cited text no. 6
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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