Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.
J Clin Neurosci. 2020 Feb;72:447-449. doi: 10.1016/j.jocn.2020.01.052. Epub 2020 Jan 22.
Visual disturbance is a common complaint in patients with multiple myeloma, both at diagnosis and later in their course, and has a broad differential. Here, we report a novel cause of visual disturbance, namely retinal ischemia due to extramedullary plasmacytomas of the orbit. A 69 year-old male patient with known multiple myeloma presented with reduced vision in his left eye. The patient had been initially diagnosed with IgG myeloma 9 months earlier and multiples lines of medical therapy had been unsuccessful. Ophthalmology review was organised and fundoscopic examination showed evidence of retinal ischemia. Computed tomography of the orbits demonstrated multiple enhancing masses within both orbits, consistent with extramedullary plasmacytomas. The presence of retinal ischemia was thus attributed to mass effect on the orbital vessels. Extramedullary plasmacytomas within the orbit are a rare manifestation of multiple myeloma, but important to consider as a possible cause of visual disturbance.
视觉障碍是多发性骨髓瘤患者常见的主诉，无论是在诊断时还是在病程后期，且病因广泛。在这里，我们报告了一种新的视觉障碍病因，即眼眶髓外浆细胞瘤导致的视网膜缺血。一名 69 岁男性患者，已知患有多发性骨髓瘤，左眼视力下降。该患者在 9 个月前被初步诊断为 IgG 型骨髓瘤，多种药物治疗均无效。安排了眼科检查，眼底检查显示视网膜缺血的证据。眼眶计算机断层扫描显示双侧眼眶内有多个强化肿块，符合髓外浆细胞瘤。因此，视网膜缺血的发生归因于眼眶血管的肿块效应。眼眶内的髓外浆细胞瘤是多发性骨髓瘤的一种罕见表现，但作为视觉障碍的可能病因，值得考虑。
