The Use of Ancillary Testing in the Diagnosis and Management of Uveitis Due to Malignancy

Nova Southeastern University, Davie, Florida, USA

Introduction. Multiple myeloma is a hematological malignancy of older adults where there is an abnormal proliferation of plasma cells. Malignant diseases can masquerade as intraocular inflammation and often be misdiagnosed as chronic idiopathic uveitis. Ancillary tests like Spectral Domain Optical Coherence Tomography (SD-OCT) can be utilized to detect signs of intraocular inflammation in the anterior chamber. We report a case of multiple myeloma mimicking a bilateral anterior uveitis. Case Report. A 60-year old black female presented with complaints of tearing, mild redness, pain and photophobia OU. PMHx is positive for multiple myeloma. BVA was 20/20 OD, OS. Biomicroscopy revealed trace cells in the anterior chamber OD and 1+ cells in the anterior chamber OS. No cells were visible with SD-OCT in the anterior chamber OD. SD-OCT revealed a couple of cells in the anterior chamber OS. Discussion. Due to the typical clinical picture of conjunctival hyperemia with circumlimbal injection and anterior chamber cells, we prescribed anti-inflammatory therapy, but also recommended she consult with her oncologist regarding re-evaluation of her multiple myeloma. Conclusion. Ophthalmic involvement associated with multiple myeloma is rare; however, with that, ancillary tests, such as SD-OCT serve as an additional tool in our armamentarium that can be utilized when evaluating and managing cases of intraocular inflammation.