title: Bilateral eyelid ecchymoses and corneal crystals: an unusual presentation of multiple myeloma.
abstract: OBJECTIVE
  This report describes a case of multiple myeloma that presented as bilateral eyelid ecchymoses and corneal crystals in the absence of widespread signs of systemic disease.
  
  
  METHODS
  A 55-year-old man was found to have the sudden appearance of bilateral eyelid ecchymoses after he flexed 90 degrees at the waist. On examination, amyloid deposition was found in the area of the lid ecchymoses, and corneal crystals were dispersed centrally and peripherally throughout all levels of the cornea on slit lamp examination. Urinalysis revealed Bence-Jones proteins and free kappa light chains. Bone marrow plasmacytosis suggested multiple myeloma.
  
  
  RESULTS
  Ophthalmic and systemic findings led to a workup, which resulted in a diagnosis of multiple myeloma.
  
  
  CONCLUSIONS
  Our case demonstrates that multiple myeloma may present clinically with ophthalmic findings such as bilateral eyelid ecchymoses and corneal crystals in the absence of widespread signs of disease. The ocular findings may be the first manifestations of disease. Therefore, a systemic workup should be performed on patients with this presentation, including urine and bone marrow analyses.
authors: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois 60612, USA. debrgold@uic.edu
authors: Debra A
authors: DA
authors: Goldstein
authors: Miriam T
authors: MT
authors: Schteingart
authors: Andrea D
authors: AD
authors: Birnbaum
authors: Howard H
authors: HH
authors: Tessler
mesh_terms: D000686:Amyloidosis / Q000175:diagnosis*; D001536:Bence Jones Protein / Q000652:urine; D003316:Corneal Diseases / Q000175:diagnosis*; D003460:Crystallization; D004438:Ecchymosis / Q000175:diagnosis*; D005141:Eyelid Diseases / Q000175:diagnosis*; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000652:urine; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000652:urine
chemical_list: D007145:Immunoglobulin kappa-Chains; D001536:Bence Jones Protein