Abstract
Background: Thalidomide is an immunomodulatory drug which is used for treatment of certain cancers such as multiple myeloma. Multiple Myeloma (MM) is a cancer that creates a specific type of white blood cell called plasma cell and accumulates these cancerous cells in bone marrow. To our knowledge, there is no report of avascular necrosis of humeral head after thalidomide use; hence, the aim of present study was to report two cases of avascular necrosis of humeral head after thalidomide use in MM patients. Case reports: Twenty five patients with history of MM were evaluated for the adverse effects of thalidomide from 2008 to 2014 at Department of Orthopedics, Isfahan University of Medical Sciences-Isfahan- Iran. All cases were assessed by X-ray and bone scan. Conclusion: Out of 25, two cases were diagnosed with avascular necrosis of humeral head with pain in shoulders. It seems that thalidomide can cause necrosis in humeral head.
Highlights
Multiple Myeloma (MM) is a disabling cancer that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance to plasma cell leukemia
We found avascular necrosis in two Iranian patients with multiple myeloma disease who were treated with thalidomide (200 mg/day) for more than 10 months
The study by Talamo, Giampaolo, et al[15] had an opposite result with our study, they concluded that avascular necrosis is a rare complication in multiple myeloma so male sex, dexamethasone dose and younger age increased risk of avascular necrosis and didn’t have relation between thalidomide and avascular necrosis
Summary
Multiple Myeloma (MM) is a disabling cancer that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance to plasma cell leukemia. Department by an oncologist owing to right upper limb pain He had been diagnosed with MM 18 months ago and had been under treatment by thalidomide (200 mg/day) for 16 months. Department by an oncologist owing to left upper limb and lumbar pain He had been diagnosed with MM 13 months ago and had been under treatment by thalidomide (200 mg/day) for 13 months. The patient used acetaminophen (PRN) for the shoulder and joint pain She had a remarkable medical history, including diabetic mellitus, for which she used metformin 500 mg/day. The patient did not use any corticosteroids, too She suffered from increasing lumbar and shoulder pain and reported having had this condition since three months ago.
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