A Case of Multiple Myeloma Misdiagnosed as Seronegative Rheumatoid Arthritis and Review of Relevant Literature.

Scott Schoninger,Natasa Milojkvovic,Alexandra Kreps,Yamen Homsi

doi:10.1155/2018/9746241

Abstract

Multiple myeloma (MM) is a malignant plasma cell proliferation producing large numbers of monoclonal immunoglobulins. Typical MM symptoms include anemia, renal failure, hypercalcemia, and bone pain. Atypical symptoms have rarely been reported in the literature. We report a case of a 58-year-old male who presented with symmetrical inflammatory polyarthritis and was misdiagnosed with seronegative rheumatoid arthritis (RA). After failing many RA treatments and with further workup, the diagnosis of MM was made. This rare manifestation of MM carries a diagnostic challenge and causes a significant delay in treating such patients. Here, we report this unusual initial presentation with review of several cases in the English literature describing similar presentations.

Highlights

Multiple myeloma (MM) is a clonal plasma cell malignancy that accounts for approximately 10% of hematologic malignancies [1]
Multiple myeloma is a cytogenetically heterogeneous, clonal plasma cell proliferative disorder, which can produce a monoclonal immunoglobulin, and which accounts for approximately 1% of neoplastic diseases and 10% of hematologic cancers [1]. e American Cancer Society estimates that 30,770 new cases of MM will occur in the US in 2018, with approximately 12,770 deaths expected to occur [2]
Rare presenting symptoms of MM can cause a significant delay in treatment and lead to unfavorable outcomes

Summary

Introduction

Multiple myeloma (MM) is a clonal plasma cell malignancy that accounts for approximately 10% of hematologic malignancies [1]. E patient endorsed swelling of the hands and wrists, difficulty making fists, as well as morning stiffness lasting more than thirty minutes He denied any constitutional symptoms such as fevers, chills, weight loss, decreased appetite, or night sweats. E patient was seen by an outside rheumatologist and treated initially with prednisone 20 mg/d and methotrexate, which was quickly escalated to a dose of 20 mg/weekly, with no response after three months of treatment He was subsequently started on antitumor necrosis factor inhibitors. Six-month follow-up showed complete resolution of joint swelling, with significant improvement in pain of the hands, wrists, and elbows. His MM remained quiescent with chemotherapy, and the patient did not require bone marrow transplant

Discussion and Literature

Findings

MM and amyloidosis