Challenging differential diagnosis, Rare disease
Naiyang Li, Zhe Zhu, Gengrong Yi, Sheng Li, Xiaotong Han
Eye Center, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, Guangdong, China (mainland)
Am J Case Rep 2018; 19:421-425
Available online: 2018-04-10
A multiple myeloma patient presenting with corneal opacity and blurred vision as chief complaint is rare.
CASE REPORT: A 54-year-old woman with a 9-month history of blurred vision without other systemic symptoms consulted an ophthalmologist. The patient had bilateral diffuse corneal opacity at the corneal epithelium and anterior stroma under slit-lamp examination. Decreased corneal endothelial cells density was found by microscopy. During consultation, the patient was noted to have an anemic face. Laboratory analysis and bone marrow were investigated. Serum protein electrophoresis revealed a raised serum kappa paraprotein band (12.4 g/L). The erythrocyte sedimentation rate (ESR) was accelerated to 49 mm/h (normal <20mm/h). There was mild kidney impairment. The blood urea increased to 8.1 mmol/L (normal <7.1 mmol/L) and creatinine increased to 158 μmol/L (normal <133 μmol/L). Then, a bone marrow biopsy was performed, showing 26% pleomorphic plasma cells (normal <15%). The patient was eventually diagnosed as having MM and was treated with systemic chemotherapy.
CONCLUSIONS: Blurred vision due to corneal opacity can be an initial presentation of MM, of which ophthalmologists should be aware.
Keywords: Antibodies, Monoclonal, Corneal Opacity, Multiple Myeloma