Li Naiyang, Zhu Zhe, Yi Gengrong, Li Sheng, Han Xiaotong
Eye Center, Zhongshan Hospital of Sun Yat-Sen University, Zhongshan, Guangdong, China (mainland).
Eye Center, Zhongshan City People's Hospital, Zhongshan, Guangdong, China (mainland).
Am J Case Rep. 2018 Apr 10;19:421-425. doi: 10.12659/ajcr.908475.
BACKGROUND 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.
以角膜混浊和视力模糊为主诉的多发性骨髓瘤患者较为罕见。
一名54岁女性，有9个月视力模糊病史，无其他全身症状，前来眼科医生处就诊。裂隙灯检查发现患者角膜上皮和前基质层双侧弥漫性角膜混浊。显微镜检查发现角膜内皮细胞密度降低。会诊期间，注意到患者面色贫血。进行了实验室分析和骨髓检查。血清蛋白电泳显示血清κ副蛋白带升高（12.4 g/L）。红细胞沉降率（ESR）加快至49 mm/h（正常<20mm/h）。有轻度肾功能损害。血尿素升高至8.1 mmol/L（正常<7.1 mmol/L），肌酐升高至158 μmol/L（正常<133 μmol/L）。随后进行骨髓活检，显示26%的多形性浆细胞（正常<15%）。该患者最终被诊断为患有多发性骨髓瘤，并接受了全身化疗。
角膜混浊导致的视力模糊可能是多发性骨髓瘤的首发表现，眼科医生应予以关注。
