Abstract
Multiple myeloma can occasionally manifest with joint disease. We report the case of an individual with a progressive bilateral carpal syndrome and a symmetrical severe seronegative polyarthritis and joint swelling. Investigations revealed an erosive seronegative inflammatory arthritis in association with bilateral carpal tunnel syndrome, anaemia, hepatic impairment and nephrotic-range proteinuria. Synovial fluid cytology demonstrated plasmablasts and multinucleated cells with products of chondrolysis. The diagnosis of multiple myeloma (with secondary amyloidosis) was made on serum protein electrophoresis and bone marrow biopsy.The relationship between myeloma and joint disease is discussed, highlighted by the presence in this case of all three pathogenic features associated with arthritis in myeloma patients- an erosive arthritis, carpal tunnel syndrome and an invasive tumoural arthritis.
Highlights
Multiple myeloma is a malignant proliferation of plasma cells producing a monoclonal paraprotein
We report an unusual presentation of multiple myeloma in the form of symmetrical severe polyarthritis and joint swelling
We have described the initial presentation of an aggressive multiple myeloma with an erosive seronegative polyarthritis due to direct myelomatous joint infiltration
Summary
Multiple myeloma is a malignant proliferation of plasma cells producing a monoclonal paraprotein. The predominant joints affected were her knees, shoulders, wrists and small hand joints; her hand function was so impaired at the time of presentation that she was no longer able to feed herself She denied joint stiffness, thigh pain, a history of skin rash, gastrointestinal or genitourinary symptoms. Journal of Medical Case Reports 2007, 1:84 http://www.jmedicalcasereports.com/content/1/1/84 She had a normochromic anaemia with a borderline leucopaenia (Hb 65 g/l, MCV 80 fl, WCC 3.9 × 109/l, platelets 200 × 109/l) and a grossly raised ESR (>140 mm/hr). Left knee synovial fluid cytology revealed atypical cells resembling plasmablasts and multinucleate cells, as well as changes consistent with chondrolysis, figure 1 It was felt this was due to malignant infiltration of cartilage, with bone and cartilage degradation products present in the fluid.
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