摘要
Kahler’s disease or “multiple myeloma” is a cancerous disease of the bone marrow. It may appear straightaway in its multiple myeloma form or in the form of solitary bone plasmacytoma or extra bone plasmacytoma. In the extra bone form, its orbital location as the first symptom is exceptional. Our case concerned a 49-year-old female patient without significant medical history who was followed for 6 months for a voluminous left exophthalmos. This ocular symptomatology was accompanied six months after by acute bone pains in the spine and pelvis then by a pathological fracture of the left trochanter. Histological assessment during the treatment showed the diagnosis of Kahler’s disease. The serum calcium was 106 mmol/l, a blood level of chloride to 96 mmol/l, of potassium to 5.36 mmol/l, of sodium to 136 mmol/l. The 24-hour proteinuria was 0.30 g/l and indicated renal impairment. The patient had anemia with a hemoglobin level to 8.8 g/l. Tumor markers were normal;in particular the CA was 13.148, ACE-2 to 1.013 ng/ml and CA19-9 to 5.029 IU/ml. The patient was transferred to a specialized unit but died before the start of treatment. Thus any isolated exophthalmos or accompanied by bone signs must systematically suggest Kahler’s disease and make undertake investigations in this direction. It is on this condition that an early management of the disease can improve the prognosis of the disease and prolong the patient’s life.
Kahler’s disease or “multiple myeloma” is a cancerous disease of the bone marrow. It may appear straightaway in its multiple myeloma form or in the form of solitary bone plasmacytoma or extra bone plasmacytoma. In the extra bone form, its orbital location as the first symptom is exceptional. Our case concerned a 49-year-old female patient without significant medical history who was followed for 6 months for a voluminous left exophthalmos. This ocular symptomatology was accompanied six months after by acute bone pains in the spine and pelvis then by a pathological fracture of the left trochanter. Histological assessment during the treatment showed the diagnosis of Kahler’s disease. The serum calcium was 106 mmol/l, a blood level of chloride to 96 mmol/l, of potassium to 5.36 mmol/l, of sodium to 136 mmol/l. The 24-hour proteinuria was 0.30 g/l and indicated renal impairment. The patient had anemia with a hemoglobin level to 8.8 g/l. Tumor markers were normal;in particular the CA was 13.148, ACE-2 to 1.013 ng/ml and CA19-9 to 5.029 IU/ml. The patient was transferred to a specialized unit but died before the start of treatment. Thus any isolated exophthalmos or accompanied by bone signs must systematically suggest Kahler’s disease and make undertake investigations in this direction. It is on this condition that an early management of the disease can improve the prognosis of the disease and prolong the patient’s life.
