A Very Rare Presentation of Multiple Myeloma: Unilateral Raccoon Eye

Abstract

Multiple myeloma (MM), the second most common hematological malignancy, is caused by the accumulation of monoclonal plasma cells in bone marrow. It accounts for 10–15% of deaths from hematological malignancies and approximately 2% of deaths from cancer. The median age at presentation is 70 years old. The diagnosis is incidental in 30% of cases. MM is often discovered through routine blood screening with a large gap between the total protein and the albumin levels.Two thirds of patients complain of bone pain, especially lower back pain. MM could be diagnosed after a pathologic fracture occurs in one third of patients. Presentation with symptoms related to hyperviscosity, hypercalcemia and bleeding tendency could also be observed. A rare presentation of MM is peri-orbital ecchymotic lesion (raccoon eye). Here, we report a 64 years old, male patient presented with unilateral raccoon eye and high erythrocyte sedimentation rate (ESR) to internal medicine outpatient. The patient was referred to hematology outpatient and was diagnosed with multiple myeloma.

Periorbital Ecchymosis (Raccoon Eye) and Orbital Hematoma following Endoscopic Retrograde Cholangiopancreatography

“…Raccoon eye is the hallmark sign of skull fracture following trauma, but it may also rarely occur in a number of nontraumatic diseases, such as migraine [ 6 ], neuroblastoma [ 9 ], and amyloidosis [ 5 ], associated with multiple myeloma [ 10 ].…”

“…In general, the conditions suggested to cause periorbital ecchymosis include disorders increasing venous pressure, causing fragile capillaries, or impairing the coagulation state [ 8 ]. Ecchymosis is also observed in several malignancies, including neuroblastoma [ 9 ] and multiple myeloma [ 10 ]. Some cases of periorbital ecchymosis have been reported to occur after procedures and interventions such as ear surgery [ 11 ], globe injury [ 12 ], rhinoplasty [ 13 ], sinus surgery [ 14 ], and continuous positive airway pressures [ 8 ].…”