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Type de présentation	E-poster
Titre	Recurrent orbital inflammation as first manifestation of multiple myeloma: a diagnostic challenge.

But	To report a rare case of recurrent orbital inflammation as first manifestation of multiple myeloma.
Méthodes	Case report.
Résultats	A 66-year-old female patient presented to our tertiary hospital due to multiple episodes of unilateral swelling in the periorbital region, proptosis, diplopia and limited ocular motility over a period of 2 years, alternating at the level of the right and left eye. CRP and sedimentation were normal. More detailed biochemical workup was negative for ANCA, IgG4, TSH, FT4, TSI and ACE. Surprisingly, protein electrophoresis revealed elevated monoclonal lambda light chains. Hematological workup tended towards the diagnosis of smouldering multiple myeloma (SMM). The strategy 'watchful waiting' was applied with close follow-up. Repeat MRI of the orbits showed diffuse fat infiltration. Biopsy could only detect chronic inflammation. We obtained a good response with oral NSAIDS. Few months later, our patient returned with bilateral visual loss and periorbital swelling. Bilateral crystalline keratopathy was noticed as a first pathognomic sign of active multiple myeloma (MM). These findings led to a revised hematologic diagnosis of active MM for which triple induction treatment was initiated. Later allogeneic stem cell transplantation was performed. After treatment of MM, we noticed complete resolution of the crystalline keratopathy without any relapse of orbital inflammation.
Conclusion	The present case describes a rare presentation of multiple myeloma with both recurrent insidious orbital inflammation and pathognomic crystalline keratopathy as sole initial findings. This case highlights the diagnostic challenge of recurrent orbital inflammation.
Conflit d'intérêt	Non

Auteur 1

Nom	MERLEVEDE
Initiales	V
Institut	University Hospital
Ville	Ghent

Auteur 2

Nom	ROELS
Initiales	D.
Institut	University Hospital
Ville	Ghent

Auteur 3

Nom	KREPS
Initiales	E.O.
Institut	University Hospital
Ville	Ghent

Auteur 4

Nom	NINCLAUS
Initiales	V.
Institut	University Hospital
Ville	Ghent