Abstract
Multiple myeloma is defined as the neoplastic proliferation of plasma cells resulting in a monoclonal gammopathy. The classic presentation of a patient is someone who presents with bone pain, osteopenia, or new onset fractures. We present a case of multiple myeloma presenting as Evan’s syndrome (ES). Evan’s syndrome is autoimmune hemolytic anaemia with autoimmune thrombocytopenia. A 44-year-old female was referred from her primary physician to the hospital as laboratory testing revealed haemoglobin of 5 gm/dL. The patient reported a two-month history of fatigue and a sixty-pound weight loss. Laboratory results demonstrated autoimmune hemolytic anaemia, C3 positivity, elevated immunoglobulin (Ig)G, elevated lactate dehydrogenase (LDH), low haptoglobin, elevated reticulocyte count, elevated RDW-CV (red blood cell distribution width-corpuscular volume), positive direct Coombs test, thrombocytopenia, and proteinuria, all of which led to an underlying ES. The patient was started on intravenous steroids followed by oral steroids. A flow cytometry, serum protein electrophoresis, and cytogenetics were obtained. A bone marrow biopsy revealed multiple myeloma and she was started on Bortezomib treatment. We present the fifth reported case of Evan’s syndrome and multiple myeloma.
Highlights
Multiple myeloma (MM) is defined as the neoplastic proliferation of plasma cells resulting in a monoclonal gammopathy
The classic presentation is a patient who presents with bone pain and associated osteolytic lesions, osteopenia, or fractures in addition to a monoclonal protein found in the serum or urine
Laboratory results demonstrated autoimmune hemolytic anemia (AIHA), C3 positivity, elevated immunoglobulin (Ig)G, elevated lactate dehydrogenase (LDH), low haptoglobin, elevated reticulocyte count, elevated RDW-CV, positive direct Coombs test, thrombocytopenia, and proteinuria, all of which led to an underlying Evan’s syndrome (ES)
Summary
Multiple myeloma (MM) is defined as the neoplastic proliferation of plasma cells resulting in a monoclonal gammopathy. The classic presentation is a patient who presents with bone pain and associated osteolytic lesions, osteopenia, or fractures in addition to a monoclonal protein found in the serum or urine. Laboratory results demonstrated AIHA, C3 positivity, elevated immunoglobulin (Ig)G, elevated lactate dehydrogenase (LDH), low haptoglobin, elevated reticulocyte count, elevated RDW-CV (red blood cell distribution width-corpuscular volume), positive direct Coombs test, thrombocytopenia, and proteinuria, all of which led to an underlying ES. As her hospital course continued, her reticulocyte count normalized following multiple blood transfusions, and her pain gradually resolved. She was initiated on bortezomib treatment prior to discharge with close outpatient hematologyoncology follow-up
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