Purpose To report an unusual presentation of ophthalmic and cutaneous plasmacytomas in a patient with relapsed multiple myeloma.
Methods A 57-year-old Hispanic female with IgG lambda multiple myeloma (MM) diagnosed in 2001 was treated with cytotoxic chemotherapy. She obtained a complete response lasting for 2 years before presenting with complaints of headache and right-sided blurred vision. Furthermore, she was found to have worsening fatigue and increasing bony pain. Upon physical exam, she was found to have two new small nodules on her right anterior chest wall and one new nodule on her right anterior abdominal wall. During examination of her right eye, a lesion was found in her conjunctiva and another in the right lateral rectus muscle insertion. All lesions were biopsied.
Results Histopathologic examination of all five lesions was consistent with plasmacytomas. She was treated with bortezomib and obtained a partial response by decreased quantitative immunoglobulins. Due to intolerability, she was switched to thalidomide. Thalidomide was quickly discontinued due to rash, and she was referred to our tertiary care center for evaluation for autologous bone marrow transplantation.
Conclusions Ophthalmic presentations of MM are rare. Those patients who present with primary ocular or orbital plasmacytomas are considered to have localized disease and have a median survival of 8.3 years. On the other hand, our patient had secondary plasmacytomas of the eye with relapsed systemic disease. These patients tend to do poorly, with a median survival of approximately 20 months. Our patient provides a good example of the rare presentation of ophthalmic plasmacytoma with MM.
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