Title

BILATERAL CRVO-RESEMBLING RETINOPATHY ASSOCIATED WITH MULTIPLE MYELOMA

Summary

Purpose: To report a case of bilateral central retinal vein occlusion-resembling retinopathy as the presenting feature of new onset multiple myeloma in an otherwise healthy man. Methods: A 50-year-old man presented with painless visual changes in both eyes for 2 months. A full comprehensive ocular examination revealed bilateral central retinal vein occlusion associated with macular edema and an inferior serous detachment. Further blood work revealed monoclonal protein in the patient’s serum and an increased percentage of plasma cells in the bone marrow. Also, multiple lithic lesions on the bone framework were observed in Computerized Tomography. He was diagnosed with immunoglobulin M multiple myeloma. Results: Initial management was plasma exchange followed by a chemotherapy regimen of zoledronate, cyclophosphamide, bortezomib, and dexamethasone, and subsequent plans for bone marrow transplant. Clinical support and chemotherapy effectively improved ocular alterations. Conclusion: Central retinal vein occlusion may be associated with systemic conditions such as hypertension and atherosclerosis; however, alternative etiologies should be considered in young otherwise healthy individuals. This case underscores the need for diligent and thorough investigations for less common systemic conditions associated with retinal vein occlusions. Finally, timely referral to the patient’s primary care physician and haematologist is important for appropriate treatment and control of underlying systemic conditions.

Area

CLINICAL CASE

Authors

Natasha Ferreira Santos da Cruz, José Arthur Pinto Milhomens Filho, Murilo Ubukata Polizelli, Desirée Mayara Nery Ferraro, Nilva Moraes