Recurrent orbital inflammatory syndrome as a presenting sign of multiple myeloma: a case report.

Introduction: Orbital inflammation has a variety of underlying causes and warrants comprehensive work-up including extensive blood work and imaging studies. This case report highlights a rare presentation of multiple myeloma presenting as recurrent orbital inflammatory syndrome.

Case report: A 61-year-old woman experienced brief episodes of recurrent orbital inflammation, as documented by MRI. Work-up revealed a high-risk smoldering myeloma without sufficient evidence of plasma cell-mediated orbital inflammation on the first biopsy samples. The CRAB criteria (hyperCalcemia, Renal insufficiency, Anemia, Bone lesions) were not met, nor were there formal criteria for myeloma. The appearance of crystalline keratopathy allowed for a diagnosis of multiple myeloma, as this ocular involvement demonstrated organ damage. Myeloma treatment led to a complete and ocular remission.

Discussion: This case emphasizes the importance of conducting a thorough systemic work-up and the need for repeated comprehensive ophthalmologic evaluations with each flare-up of recurrent orbital inflammation. Subtle but rare changes observed during follow-up can provide critical information that may alter the diagnosis.