Myeloma cast nephropathy presenting as acute onset bilateral reversible hearing loss.

A case of myeloma cast nephropathy masquerading as bilateral deafness of acute onset, probably due to hyperviscosity syndrome, is presented. Audiometry and kidney biopsy confirmed the diagnosis. Despite the presence of multiple poor prognostic features, the patient responded satisfactorily to plasmapharesis, dialysis and chemotherapy (VAD regimen) along with other supportive measures. The patient had excellent renal recovery, but hearing improvement was delayed for 1 month. Various causes of hearing loss in patients with multiple myeloma and available therapeutic options are discussed.