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Clinicopathologic Reports,Case Reports, and Small Case Series
June 2001

Serous Macular Detachments in a Patient With IgM Paraproteinemia: An Optical Coherence Tomography Study

Arch Ophthalmol. 2001;119(6):911-913. doi:

An unusual maculopathy with macular detachment has been described in patients with immunogammopathies. We observed this type of maculopathy in a patient with type 2 diabetes mellitus and had the opportunity to study the condition with optical coherence tomography. Optical coherence tomography showed not only a neurosensory macular detachment, but also a retinal pigment epithelium (RPE) detachment.

A 77-year-old man with type 2 diabetes mellitus had reading and driving difficulties. Physical examination revealed poor diabetic control and monoclonal IgMλ paraproteinemia (IgM level, 46 g/L; reference range, 0.4-2.3 g/L), with 52% plasmocytes in bone marrow aspirate. There was mild anemia (hemoglobin level, 9-11 g/L) and carotid insufficiency, with 50% to 80% stenosis of the left internal carotid artery and no significant abnormalities in other arteries. The patient was normotensive without intake of antihypertensive agents, and there was no evidence of heart or kidney disease. Initially the diagnosis of Waldenström syndrome was made, and the patient was treated accordingly with intermittent plasmapheresis and chlorambucil. Eight months later, the diagnosis was revised to IgM myeloma based on the typical plasma cell appearance of malignant cells in the bone marrow, the presence of a few osteolytic lesions, the absence of hepatosplenomegaly or lymphadenopathy, and progression under chlorambucil treatment. Treatment was changed to 4 to 6 weekly courses of melphalan and methylprednisolone.

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