Georgakopoulos Constantine D, Plotas Panagiotis, Angelakis Angelos, Kagkelaris Konstantinos, Tzouvara Evangelia, Makri Olga E
Department of Ophthalmology, Medical School, University of Patras, Patras, Greece.
Department of Internal Medicine, Medical School, University of Patras, Patras, Greece.
Ther Adv Ophthalmol. 2019 Jan 8;11:2515841418820441. doi: 10.1177/2515841418820441. eCollection 2019 Jan-Dec.
We describe a case where hyperviscosity retinopathy and immunogammopathy maculopathy were the presenting features of IgA multiple myeloma and report the response of maculopathy to intravitreal injection of dexamethasone implants.
A 56-year-old man presented at the Department of Ophthalmology with the chief complain of reduced vision for the past 10 days in both eyes. Ophthalmic examination revealed central retinal vein occlusion resembling signs with severe macular edema in both eyes with prominent serous macular detachment. After comprehensive evaluation, an IgA type kappa multiple myeloma was diagnosed complicated with hyperviscosity-associated retinopathy and immunogammopathy maculopathy. Patient was treated with multiple sessions of plasmapheresis, systemic chemotherapy, and finally intravitreal implants of dexamethasone with complete restoration of macular edema and serous macular detachment in both eyes. The visual function and the hyperviscosity-associated retinopathy were partially restored.
Ocular manifestation might be the only presenting sign of a life-threatening disease such as IgA multiple myeloma. A high level of suspicion is required to diagnose and treat such cases promptly and effectively.
我们描述了一例以高黏滞性视网膜病变和免疫球蛋白病性黄斑病变为首发表现的IgA多发性骨髓瘤病例，并报告了黄斑病变对玻璃体内注射地塞米松植入物的反应。
一名56岁男性因双眼视力下降10天为主诉就诊于眼科。眼科检查发现双眼视网膜中央静脉阻塞样体征伴严重黄斑水肿及明显的浆液性黄斑脱离。综合评估后，诊断为IgAκ型多发性骨髓瘤，并发高黏滞性相关性视网膜病变和免疫球蛋白病性黄斑病变。患者接受了多次血浆置换、全身化疗，最后行玻璃体内地塞米松植入术，双眼黄斑水肿和浆液性黄斑脱离完全消退。视觉功能和高黏滞性相关性视网膜病变部分恢复。
眼部表现可能是诸如IgA多发性骨髓瘤等危及生命疾病的唯一首发体征。需要高度怀疑，以便及时有效地诊断和治疗此类病例。
