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Presentation type	E-poster
Title	Recurrent orbital inflammation as first manifestation of multiple myeloma: a diagnostic challenge.

Purpose	To report a rare case of recurrent orbital inflammation as first manifestation of multiple myeloma.
Methods	Case report.
Results	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.
Conflict of interest	No

Authors 1

Last name	MERLEVEDE
Initials	V
Department	University Hospital
City	Ghent

Authors 2

Last name	ROELS
Initials	D.
Department	University Hospital
City	Ghent

Authors 3

Last name	KREPS
Initials	E.O.
Department	University Hospital
City	Ghent

Authors 4

Last name	NINCLAUS
Initials	V.
Department	University Hospital
City	Ghent