Title
RETINAL MANIFESTATION IN MULTIPLE MYELOMA
Introduction
To show retinal findings in a patient with hyperviscosity syndrome secondary to multiple myeloma (MM)
Methods
60-year-old white woman had come to Hospital with seizures,mental confusion,epistaxis, hear loss.She was admitted to intensive care unit initially treated with vasoactive drugs. Pertinent laboratory findings included elevated serum IgG immunoglobulin of 4385 mg/dL and serum protein electrophoresis showed monoclonal M spike of 5.24 g. A bone marrow biopsy was then performed and showed large aggregates of plasma cells. Immunohistochemical stains showed that the plasma cells were kappa light-chain restricted,which was consistent with multiple myeloma.A skeletal survey shows occult lytic lesions vertebrae. The hematology called for ophthalmologic evaluation thinking in hyperviscosity syndrome Posterior segment examination showed numerous large retinal hemorrhages throughout the pole posterior and midperiphery along with mild vascular tortuosity in both eyes. The patient was submitted to 5 five session of plasmapheresis at the beginning of treatment and after started chemoterapy.
Results
Conclusion:hyperviscosity syndrome is a rare manifestation MM and when it occurs,can present concomitant retinopathy, with large hemorrhages and tortuous and dilated veins.There is association between central and branch vein occlusion with hyperviscosity syndrome.
Discussion
Discussion: Myeloma patients with retinopathy generally have significant reduced hemoglobin and platelet counts. The presence of retinopathy is not associated with a worse prognosis of MM and improves with systemic treatment. Common signs are discrete flame and Roth spot hemorrhages, cotton wool spots and microaneurisms.That signs included: dilated and tortuous retinal veins,superficial and deep retinal hemorrhages along with retinal edema. Central retinal and branch retinal vein occlusion can be associated with hyperviscosity retinopathy.
Keywords
multiple myeloma,hiperviscosity retinopathy
Area
CLINICAL CASE
Authors
PAULO KIN TAKARA, LETICIA SANT'ANA CARDOSO SILVA, JANAINA LUCILA BRABO, IONE FEIJAO ALEXIM