Pseudohypopyon due to malignant infiltration of the anterior chamber in multiple myeloma

Sir, Ocular involvement is rare in multiple myeloma and is mainly due to the presence of paraproteins.1, 2, 3 Direct infiltration of plasma cells into the eye is exceedingly rare. Here, we

report a case of abnormal plasma cell infiltration in the eye of a patient with myeloma, which presented as a pseudohypopyon. CASE REPORT A 75-year-old female, who had been diagnosed with

myeloma 4 months ago, was referred for an ophthalmic evaluation. She had complained of a 2-week history of visual deterioration with mild discomfort in the right eye. Ocular examination

revealed conjunctival hyperemia, posterior synechiae, fine keratic precipitates, a hypopyon (Figure 1), and a mild vitritis in the right eye with a visual acuity of 6/18. The left eye was

normal. Clinically there was no evidence of systemic infection. Vitreous and aqueous taps obtained did not reveal any microbial growth, but demonstrated the presence of small and mature

multinucleated plasma cells on microscopy (Figure 2a Giemsa staining). Flow cytometric immunophenotyping of cells both from the blood and from the aqueous sample (Figure 2b–d) demonstrated

the presence of the myeloma phenotype characterised by CD19−/CD20−/CD45−/CD38+/CD138+/CD56+.4, 5, 6 The patient, already on thalidomide at this point, was commenced on a course of mild

topical steroids (0.5% prednisolone) four times daily as well as 0.5% cyclopentolate bd. Although there was symptomatic improvement, a small pseudohypopyon remained after 8 weeks of therapy

with no change in visual acuity. Sadly, this patient succumbed to the disease 3 months later. COMMENT Direct ocular involvement in myeloma has been reported,7, 8 but only one report has

demonstrated definitively, by the use of immunohistochemistry, the identity of the malignant cells within the anterior chamber. 8 Myeloma plasma cells are phenotypically abnormal, and have

been shown to be distinguishable from normal plasma cells with flow cytometric analysis on the basis of their low expression of CD19 and CD45 and higher levels of expression of CD138 and

CD38 with or without increased expression CD56.4, 5, 6 Our study has demonstrated that flow cytometric analysis for the detection of malignant phenotypes is possible in small aqueous

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Ophthalmol_ 2002; 120: 87–88. PubMed  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Ophthalmology and Visual Sciences, Eye and ENT Centre,

Queens Medical Centre, University of Nottingham, Clifton Boulevard, Nottingham, NG7 2UH, UK J H Chan & H S Dua * Department of Ophthalmology, Royal Free Hospital, Pond Street, London,

NW3 2 QG, UK P G Tranos & J D Jagger * Department of Haematology, St Mary's Hospital, Praed Street, London, W2 1NY, UK F L Lim Authors * J H Chan View author publications You can

also search for this author inPubMed Google Scholar * H S Dua View author publications You can also search for this author inPubMed Google Scholar * P G Tranos View author publications You

can also search for this author inPubMed Google Scholar * J D Jagger View author publications You can also search for this author inPubMed Google Scholar * F L Lim View author publications

You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to J H Chan. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS

ARTICLE Chan, J., Dua, H., Tranos, P. _et al._ Pseudohypopyon due to malignant infiltration of the anterior chamber in multiple myeloma. _Eye_ 19, 112–113 (2005).

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