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Endogenous Panophthalmitis in a case of Multiple Myeloma and Diabetes Mellitus
Madhurima K Nayak1, Neha Singh2
1Senior Resident, Department of Ophthalmology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India .
Abstract:
Multiple myeloma cripples the human body in many ways, one of them being decreased immunity. Infections occurring spontaneously can increase the morbidity. We report a case of an elderly lady with multiple myeloma on treatment and uncontrolled diabetes, who developed loss of vision, swelling and redness of left eye of 4 days duration. There was no history of injury or entry of a foreign body. She also had left arm cellulitis. Ocular examination revealed visual acuity of 6/36 in right eye and no perception of light in left eye. Anterior segment of the right eye was insignificant while the left eye showed features suggestive of panophthalmitis. B scan revealed choroidal detachment and confirmed panophthalmitis. She underwent evisceration of the left eye. The cause of spontaneous infections is an immunocompromised state due to multiple myeloma and uncontrolled diabetes. This case report highlights the propensity of multiple myeloma to cause infections of the eye debilitating enough to cause severe visual morbidity.
Insights
Multiple myeloma and uncontrolled diabetes can lead to severe eye infections and vision loss. This case highlights spontaneous panophthalmitis in an immunocompromised patient, emphasizing the need for vigilant monitoring.
Area of Science:
- Ophthalmology
- Hematology
- Infectious Diseases
Background:
- Multiple myeloma is a hematologic malignancy associated with significant immune compromise.
- Uncontrolled diabetes further exacerbates immune dysfunction, increasing infection risk.
- Spontaneous ocular infections can lead to severe visual morbidity in immunocompromised individuals.
Observation:
- An elderly female patient with multiple myeloma and uncontrolled diabetes presented with acute vision loss, eye swelling, and redness.
- Ocular examination revealed no perception of light in the left eye with features of panophthalmitis.
- Associated left arm cellulitis was noted, suggesting a systemic infectious process.
Findings:
- B-scan ultrasonography confirmed panophthalmitis and choroidal detachment in the affected left eye.
- The patient underwent evisceration of the left eye due to the severity of the infection.
- Laboratory findings indicated an immunocompromised state due to both multiple myeloma and diabetes.
Implications:
- This case underscores the critical link between multiple myeloma, diabetes, and severe, spontaneous ocular infections.
- Ophthalmologists and oncologists should be aware of the potential for aggressive eye infections in such patients.
- Early recognition and management are crucial to prevent devastating visual outcomes in immunocompromised individuals.
