Smoldering multiple myeloma revealed by superior ophthalmic vein thrombosis

Abstract

Superior ophthalmic vein thrombosis is a rare entity. It is associated with significant morbidities. It may present with dramatic clinical signs. It is frequently secondary to cavernous sinus pathology and it can be a harbinger of cavernous sinus thrombosis. We report an unusual case of superior ophthalmic vein thrombosis, as the first manifestation of multiple myeloma. As far as we know, this is the first case described in the literature. Here we describe a patient presented with a painful, visual blur and a right-sided proptosis due to superior ophthalmic vein thrombosis. Appropriate medical workup was conducted, and smoldering multiple myeloma was diagnosed as the underlying cause. We further discuss the possible involved mechanisms.

Keywords: Hyperviscosity syndrome; multiple myeloma; ophthalmoplegia; proptosis; superior ophthalmic vein.

Figure 1

A photograph showing: (a) Right periorbital swelling with mild erythema, ecchymosis, subconjunctival hemorrhage, dilated and tortuous episcleral veins; (b and c) showed a restricted ocular motility

Figure 2

Computed Tomography Scan of the orbits: (a) axial section, (b) coronal reconstruction of the venous phase of computed tomography angiography: The arrow is pointing to dilated right superior ophthalmic vein thrombosis and enlarged extraocular muscles

Figure 3

Brain MRI (T1 Gadolinium-enhanced): (a) axial section, (b and d), coronal section, (c) sagittal section: the arrow is pointing to right SOVT, (b) T1 coronal section: the arrow is pointing to the partial extension of thrombus into the right cavernous sinus

Figure 4

External photographs at 1-week follow-up; (b and c): no limitation of ocular motility