Hyperviscosity Retinopathy and Immunogammopathy Maculopahy as New Onset of Multiple Myeloma

Abstract

The purpose is to report a case of immunogammopathy maculopathy and hyperviscosity retinopathy as the presenting feature of new-onset multiple myeloma (MM) in an otherwise healthy man. A 50-years-old man presented with painless visual changes in both eyes for 2 months. Ocular examination revealed bilateral CRVO-like associated with macular edema (ME) and an inferior serous detachment. Hematologic investigation revealed an increased percentage of plasma cells in the bone marrow, reaching the diagnosis of MM IgM/kappa. Clinical support and chemotherapy effectively improved ocular alterations, despite the residual ME. Injection of triamcinolone was carried out, without any response. Bilateral vision reduction with hyperviscosity syndrome-related retinopathy and immunogammopathy maculopathy was the first manifestation of an underlying systemic and potentially fatal disease. This case highlights the need for diligent and thorough investigations for less common systemic conditions associated with retinal vein occlusions.

Retinal Findings in Hyperviscosity Syndromes

“…Bu hastalar kanın pıhtılaşmasında rol oynayan FVIII proteininin kanda ya normal düzeyinin altına inmesi ya da tamamen olmamasından dolayı normal bireylerde görülenden daha uzun bir pıhtılaşma süresi göstermektedirler. [15] Bu bireylerde görülen kanamalar özellikle eklem yerlerinde, kaslarda ve yumuşak dokularda meydana gelmektedir. Koagülasyon defekti ile oluşan Hemofili hastalığında travma yada cerrahi girişimler sırasında ciddi periorbital yada intrakamaral yada cok nadir olarak intravitreal kanamalar da oluşabilir ve ayrıca spontan oküler kanamalarda meydana gelebilmektedir.…”