Cavernous sinus syndrome as the initial manifestation of multiple myeloma

A 76-year-old man developed a cavernous sinus syndrome as the initial manifestation of multiple myeloma. Although clinically the patient had stage IA disease, which is typically associated with a favorable response to therapy, his disease was rapidly fatal. This case emphasizes a weakness of the traditional staging system because it does not take into account certain clinical and histopathologic aspects of myeloma relevant to extramedullary plasmacytomas. Since disorders of ocular motility are more likely to be associated with extramedullary myeloma than myeloma confined to the marrow, clinicians need to be aware of the limitations in the clinical staging system and the potential problems associated with anaplastic plasmacytomas.