Multimodal Imaging of Vitelliform Lesions in Multiple Myeloma: A Case Report

We report the case of a patient with multiple myeloma who presented acutely with bilateral vitelliform-like macular lesions. This 85-year-old Caucasian lady was referred for treatment of presumed bilateral neovascular age-related macular degeneration (nAMD). Interestingly, this was a few months after starting on chemotherapy for multiple myeloma. We performed a clinical examination and multimodal imaging. This comprised colour fundus photography, fundus autofluorescence, near-infrared fundus photography, spectral-domain optical coherence tomography, and optical coherence tomography angiography. These tests excluded nAMD and demonstrated instead vitelliform-like macular lesions. Subfoveal vitelliform-like macular lesions, believed to be subretinal deposition of immunoglobulin, are one of the retinal signs of multiple myeloma. This can present acutely mimicking nAMD. These retinal lesions can be a presenting manifestation of the disease or may present later on during the course of the disease. Therefore, acute presentation of vitelliform macular lesions in an elderly patient should arouse suspicion. Serum protein electrophoresis is recommended to detect multiple myeloma at an early stage.