Seya A, Terano T, Hattori Y, Tomizuka T, Morio H, Kino T, Hirai A, Nishikawa T, Tamura Y, Yoshida S
Second Department of Internal Medicine, School of Medicine, Chiba University Hospital.
Intern Med. 1993 Nov;32(11):875-8. doi: 10.2169/internalmedicine.32.875.
We report a patient with malignant exophthalmos associated with multiple myeloma which showed no evidence of direct orbital involvement of plasma cells. This exophthalmos had similarities with Graves' ophthalmopathy, but the patient had no detectable autoimmune thyroid diseases. Plasmapheresis was effective not only for the treatment of heart and renal failure due to the myeloma kidney but also for the malignant exophthalmos. As the serum monoclonal IgG level was decreased by plasmapheresis, the improvement of proptosis, visual acuity, and hypertrophy of the extraocular muscle as measured by magnetic resonance imaging were observed. It is suggested that humoral factors removed by plasmapheresis might be involved in the pathogenesis of this nonendocrine exophthalmos.
我们报告了一名患有恶性突眼症且合并多发性骨髓瘤的患者，该患者未显示浆细胞直接累及眼眶的证据。这种突眼症与格雷夫斯眼病有相似之处，但该患者未检测到自身免疫性甲状腺疾病。血浆置换不仅对因骨髓瘤肾病导致的心脏和肾衰竭有效，对恶性突眼症也有效。由于血浆置换使血清单克隆IgG水平降低，观察到眼球突出、视力以及通过磁共振成像测量的眼外肌肥大情况均有改善。提示血浆置换去除的体液因子可能参与了这种非内分泌性突眼症的发病机制。
