To report a case of multiple myeloma masquerading as chronic uveitis in an elderly woman.
Retrospective observational study
A 63-year-old Asian woman presented with bilateral chronic anterior uveitis for a year. Thera was no systemic illness. BCVA was 6/18 OD and 6/12 OS. Slit lamp examination revealed bilateral circumcorneal congestion, corneal edema, anterior chamber cells & flare 2+ and few vitreous cells. Indirect ophthalmoscopic examination showed the presence of fine retinal folds at the posterior pole in both the eyes. Ultrasound bio microscopy showed the presence of trace ciliary body effusion with thickening of the pars plana. Fluorescein angiography revealed the presence of disc leak and cystoid macular edema. Optical coherence tomography showed the presence of retinal pigment epithelium and choroidal folds along with cystoid macular edema. Routine blood investigations revealed thrombocytopenia with a platelet count of 84,000 cells/mm3 and she was then referred to a hematologist. A bone marrow biopsy and aspirate showed the presence of clones of malignant plasma cells. The serum protein electrophoresis showed an M Protein band with hyperproteinaemia and hypergammaglobulinemia. Aqueous fluid also revealed the presence of the M protein band, characteristic of multiple myeloma. She was treated with topical and periocular steroids. She was also started on chemotherapy including bortezomib, lenalidomide and dexamethasone. At the last follow up after 6 months, there was complete resolution of anterior uveitis without any recurrence.
Recurrent uveitis can be a sign of multiple myeloma in an elderly patient.