DOI: https://doi.org/10.36347/sjmcr.2026.v14i08.026

Pages: 1875-1878

Multiple myeloma (MM) is a malignant plasma cell disorder characterized by uncontrolled proliferation of plasma cells in the bone marrow and overproduction of monoclonal immunoglobulins. The resulting immune dysfunction predisposes patients to severe infections. Rarely, ocular infections may constitute the first clinical manifestation of MM. We describe the case of a 65-year-old male, initially treated for herpes zoster ophthalmicus, who subsequently developed a severe corneal abscess in the left eye. Ophthalmologic examination revealed a central stromal abscess with hypopyon, progressing to endophthalmitis despite intensive fortified topical antibiotics and intravitreal injections. Corneal cultures isolated Pseudomonas aeruginosa. Concurrent laboratory investigations showed bicytopenia, hypoalbuminemia, and a monoclonal IgA lambda peak. Bone marrow aspiration revealed 66% infiltration by dystrophic plasma cells, confirming MM. The patient was treated with a VRD protocol (bortezomib, lenalidomide, dexamethasone) with partial hematologic response. The ocular infection eventually resolved, leaving a dense corneal opacity. This case illustrates that a corneal abscess due to Pseudomonas aeruginosa may reveal an underlying multiple myeloma. Refractory or unusually severe infections should raise suspicion of systemic immunosuppression and warrant a complete diagnostic evaluation.