[BILATERAL OCULAR PLASMACYTOMA PRESENTING AS ACUTE ANTERIOR UVEITIS]

INTRODUCTION

A 64-year-old woman, presented to the ophthalmology outpatient clinic with abrupt onset of pain, blurred vision and redness in her right eye. Her medical history is remarkable for multiple myeloma, with successful bone marrow transplantation and recurrent disease as secondary plasma cell leukemia, managed with a biologic agent. Examination revealed severe fibrinous anterior uveitis, accompanied by keratic precipitates, rubeosis iridis and raised intra-ocular pressure (IOP) and normal fundus. The patient was treated intensively with topical steroids, IOP lowering agents, systemic acyclovir and prednisone. Response was partial, with further development of posterior synechiae, iris bombe and 360o angle closure. An anterior segment ultrasound demonstrated severely thickened iris. The appearance of bilateral sub-conjunctival salmon patches in both eyes facilitated histopathologic diagnosis by extraocular tissue biopsy which revealed plasma cells infiltration, suggestive of plasmacytoma. Ruthenium plaque radiotherapy administered in a 40Gy dose was initiated in both eyes with a new cycle of systemic chemotherapy. Complete regression after treatment was achieved bilaterally.

AIMS

To report a case of bilateral ocular plasmacytoma presenting as an acute anterior uveitis.

BACKGROUND

Plasmacytoma, associated with multiple myeloma, is a solid tumor of the lymphoid system composed of monoclonal plasma cells. Ocular involvement is rare and direct infiltration of both eyes is even rarer.

METHODS

A case report.

CONCLUSIONS

Extramedullary plasmacytoma rarely involves ocular structures. In the setting of systemic malignancy, ocular involvement should be considered, especially when acute inflammation is recalcitrant to therapy.

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Microstructure and mechanics of human resistance arteries

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Smoking and periodontal disease: discrimination of antibody responses to pathogenic and commensal oral bacteria

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