Concomitant multiple myeloma spectrum diagnosis in a central retinal vein occlusion: a case report and review

Abstract

Multiple myeloma is a neoplastic plasma-cell disorder resulting from malignant plasma cells in the bone marrow. It can cause a hyperviscosity syndrome secondary to the paraproteinaemia associated with the disease. The increased hyperviscosity can lead to retinal vein occlusions and other ocular problems that may challenge clinicians. In patients with multiple myeloma and hypertension and/or diabetes mellitus, retinal changes appear similar and changes due to one disease or the other may be difficult to determine. A 48-year-old white female presented to the clinic with a complaint of blurry vision in her left eye. A full comprehensive ocular examination revealed a central retinal vein occlusion presumably from the patient's history of hypertension, diabetes mellitus and hypercholesterolaemia. Further bloodwork revealed monoclonal protein in the patient's serum and an increased percentage of plasma cells in the bone marrow. She was diagnosed with monoclonal gammopathy of undetermined significance, part of the multiple myeloma disease spectrum. She was referred to a retinal specialist for initiation of intravitreal injections of anti-vascular endothelial growth factor. Multiple myeloma has been implicated in younger patients as an underlying cause of retinal vein occlusions. Multiple myeloma should be considered as a differential diagnosis in young patients with retinal vein occlusions, even if other risk factors for venous occlusion like hypertension, diabetes mellitus and hypercholesterolaemia are present. Timely referral to the patient's primary care physician and haematologist is important for appropriate treatment and control of underlying systemic conditions.

Novel Classification of Early-stage Systemic Hypertensive Changes in Human Retina Based on OCTA Measurement of Choriocapillaris

“…Regarding the second limitation, retinal vasculature and choroidal vasculature are also affected by systemic hypertension. In eyes with retinal diseases 16 , 17 , such as diabetic retinopathy 21 – 23 , retinal vascular occlusion 24 , and epiretinal membrane disorders 18 , the retinal vasculature is expected to show changes that make the estimation of systemic hypertensive vascular changes difficult. OCTA cannot distinguish between the small-vessel and large-vessel layers of the choroidal vasculature and might generate an overlapped microvascular image.…”

“…Retinal vasculature and choroidal vasculature are affected by systemic hypertension, and are also Retinal and choroidal vasculature is expected to change with age 10 , 11 , axial length (AL) 12 , 13 , intraocular pressure (IOP) 14 , 15 , and many diseases 16 – 24 . Such as diabetic retinopathy, retinal vascular occlusion, and epiretinal membrane disorders, making the estimation of systemic hypertensive vascular changes difficult.…”

Detailed Structure and Pathophysiological Roles of the IgA-Albumin Complex in Multiple Myeloma

“…Hyperviscosity syndrome is a common complication in patients with multiple myeloma [25]. This complication may correlate with disease survival [26] because of the prolonged half-life albumin-bound IgA. Previous reports suggested that hyperviscosity syndrome in multiple myeloma may be responsible for increased blood cells (erythrocytes, leukocytes, and platelets) and macromolecules (mainly immunoglobulins) in the blood [25].…”

Combined Coagulopathy Can Induce Both Hemorrhagic and Thrombotic Complications in Multiple Myeloma

“…CRVO is known to be associated with MM. In this context, CRVO mainly occurs due to hyperviscosity syndrome ( 8 ). In addition, various coagulation disorders can also trigger this complication ( 9 ).…”