Proptosis : A Rare Presenting Feature Of Multiple Myeloma.
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Transcript of Proptosis : A Rare Presenting Feature Of Multiple Myeloma.
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Proptosis : A rare presenting feature of multiple myeloma
Dr. Asra SalehaJR3 ophthalmologyIGGMC Nagpur
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U/L painless proptosis – varied causes
Multiple myelomamalignancy of reticuloendothelial cells not an uncommon conditionBut orbital involvement rare
Multiple myeloma presenting as U/L painless proptosis is rare
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Case reportA 55-year-old-man presented with painless progressive unilateral right sided proptosis with restricted ocular movements of 60 days duration. He also had history of chronic lower back pain , further examination suggested of localised painless anterior chest swelling .DD
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Ocular examination
Right eye
Left eye
Visual acuity 4/60 6/9Pupil RAPD NSRLAnterior segment
proptosis WNL
O/M Restricted in all gazes
WNL
FUNDUS Optic disc edema
WNL
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Investigations CBCSERUM CALCIUMKFTXRAY CHESTB SCANCT HEAD AND ORBITLOCAL USG FNACMRI HEAD AND ORBIT
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MRI of the orbit showing involvement of the greater wing of the sphenoid along with right orbital extension, involving the lateral rectus muscle and the lateral wall of the orbit as well as a right-sided preseptal soft tissue swelling and thickening
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DiagnosisMultiple myeloma with unilateral
orbital metastasis with right sided proptosis and optic neuropathy
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Management Injection methyl prednisoloneInjection dexamethasoneInjection lenalidomideLocal therapy for proptosis
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Management
Initial presentation
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Presentation of the right eye after chemo therapy.
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Discussion In Multiple myeloma metastasis of the
orbit is a rare, but a serious condition. Involvement of almost every ocular structure has been reported . Most common clinical presentation includes proptosis, redness, pain, diplopia, and decreased vision. Unilateral involvement of one eye is not uncommon. It is argued that myelomatous changes of the orbit are common, even though clinical presentation is extremely rare .
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Discussion Solitary extramedullary orbital plasmacytoma
as an initial presenting feature in a multiple myeloma patient has also been reported. In most of the cases reported, CT scan was the imaging modality of choice. Treatment options include systemic chemotherapy and local radiation and often good response to these options is noted . Our case is unique because of its dramatic presentation as seen in the images and quick resolution of the symptoms after a very short duration of chemotherapy