Bilateral Endogenous Bacterial Endophthalmitis and Bacteraemia as the presenting manifestation of Multiple Myeloma. Peter Cikatricis Peter Cikatricis 1, 3 Korina Theodoraki Korina Theodoraki 1 Yit C.Yang Yit C.Yang 3, 4 Alastair K.O. Denniston Alastair K.O. Denniston 1, 2, 3 1 Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom 2 Centre for Translational Inflammation Research, University of Birmingham, Birmingham, United Kingdom 3 Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom 4 Aston University, Birmingham, United Kingdom Ocular History 59-year old Caucasian male 12/ day history of painless decrease of vision in both eyes (L > R) Headache, Fever, Nausea and Vomiting POcHx: Left strabismic amblyopia (20/40 BCVA) PMHx: Dental work 2 weeks prior, ex-smoker DHx: Nil First Clinical Presentation Bilateral asymmetric vitritis with left panuveitis Fundus infiltrative lesions (OS and ?OD) Systemic signs of infection Examination at First Presentation Fever 39.5 C (103.1F) Tachycardia 122 bpm Auscultation Grade 4/6 Pan-systolic murmur EYERightLeftBCVA20/40HM A/S & IOP Unremarkable, 12 Ciliary injection, 14 A/C Cells +, Flare + Cells 2-3+, Hypopyon Pupil Reactive/No RAPD PS++ LensClearClear Vitreous Few Cells Fundus Roth spots? minimal exudate Right Eye Vitreous Marked vitritis (Grade 4 haze) Fundus Very limited view Left Eye Differential Diagnoses Infection: Bacterial Viral HIV/Syphilis Toxoplasmosis Fungal Inflammation: Atypical Sarcoidosis Severe HLA- B27-ass. Masquerade: Lymphoma Other blood malignancies Paraneoplastic Initial Investigations Bloodwork (CBC, biochemistry, ESR, CRP, ACE, Ca 2+, ANA, ANCA, TPHA, HIV, Toxoplasma, Borrelia, TB T-Spot) Blood cultures CT/MRI of head and chest Trans-oesophageal Echocardiogram requested Lab Results ESR 62 mm/h (