<p>Bilateral Proptosis in a Case of Recurring Multiple Myeloma: Uncommon Orbital Presentation of Plasmacytoma</p>

Abstract

Multiple myeloma is a malignant plasma cell dyscrasia that may invade the orbits in extramedullary presentations. Common manifestations of orbital involvement include unilateral proptosis, injection, chemosis, diplopia, and occasionally pain. Additionally, the soft-tissue tumors associated with multiple myeloma typically cause bony destruction of adjacent structures. However, in certain patients, bilateral proptosis and a lack of bony destruction may occur. In these instances, it is important for physicians to consider patient history, presentation, and progression in order to ensure that a potentially fatal diagnosis is not missed. The reason this case is important is two-fold: 1) we describe a case of an individual with relapsing multiple myeloma presenting as bilateral proptosis and lacking bony destruction, highlighting the importance of understanding the disease process and 2) we discuss why patients with multiple myeloma may be more prone to developing tumors of the orbit in recurrent cases.

Bilateral Orbital Plasmacytomas With Orbital Compartment Syndrome

“…Orbital plasmacytoma can be the presenting symptom of undiagnosed MM, or of uncontrolled and recurrent disease, such as in this case. The vast majority of these patients have unilateral involvement, with proptosis being the most common finding [ 4 ]. This case is an atypical presentation due to the bilateral involvement (12% of cases).…”

“…Plasmacytomas are associated with MM, a plasma cell neoplasm that is most often confined to the bone marrow and presents with symptoms such as bone pain, infection, hypercalcemia, anemia, and renal involvement [ 4 ]. Extramedullary plasmacytomas have been previously reported to be present at diagnosis in about 7% of MM cases [ 5 ].…”

Clinical features and prognosis of multiple myeloma and orbital extramedullary disease: Seven cases report and review of literature

“…Orbital involvement is most common in patients with active MM disease, invasion of the orbit may be one of the extramedullary lesions, or may be the first manifestation of disease recurrence[ 14 , 15 ]. Of seven patients in this study, two patients presented with ocular involvement as the primary symptom (28.6%), and the remaining 5 patients developed periocular EMD after the diagnosis of MM was established (71.4%).…”

Orbital plasmasitom

“…Hastalığın kesin etiyolojisi belli olmamakla beraber plazma hücrelerinin proliferasyonu ve diferansiyasyonunun bazı sitokinlerle ilişkili olduğu düşünülmektedir. Bunlar arasında en önemlisi interlökin-6' dır (4,5). Aktif hastalığı bulunan olgularda bu sitokin yüksek bulunmaktadır ve bu durumun kötü prognoz ile ilişkili olduğu düşünülmektedir (5).…”

“…Bunlar arasında en önemlisi interlökin-6' dır (4,5). Aktif hastalığı bulunan olgularda bu sitokin yüksek bulunmaktadır ve bu durumun kötü prognoz ile ilişkili olduğu düşünülmektedir (5).…”