Purpose

To report an unusual case of a 66-year-old man who presented with left-sided proptosis, hypoglobus and binocular vertical diplopia as the initial manifestations of multiple myeloma

---

Methods

We report a case of a 66-year-old man who presented with left-sided proptosis, hypoglobus and binocular vertical diplopia. A computed tomography scan performed shortly after his admission, showed a homogenous mass in the left superior orbit.
The lesion was extraconal and was associated by an adjacent bone destruction.

A lid crease approach was used to expose the mass which was located superior and posterior to the lacrimal gland. Histopathological examination of the tissue specimen confirmed the diagnosis of multiple myeloma.

---

Results

The patient has undergone multiple biological therapies, chemotherapy, and radiotherapy to the left orbit. He is currently free of disease and reports good overall well-being. Ophthalmologic examination reveals normal anterior and posterior chambers of the left eye, with preserved ocular motility and no evidence of optic nerve involvement.

---

Conclusion

Bone pain, typically involving the axial skeleton, is the most common clinical presentation of multiple myeloma. Other systemic symptoms as fatigue and weight loss are also frequent.
In the case presented here, however, the initial manifestations of multiple myeloma were proptosis and diplopia, despite orbital involvement being relatively rare. This case highlights the necessity of considering systemic malignancies in the differential diagnosis of orbital masses also in the lacrimal gland fossa.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Ehud	Reich	Shaare Zedek Medical Center

↑ Back to top