Abstract
Multiple myeloma is a hematological malignancy characterized by an abnormal proliferation of monoclonal plasma cells. In some occurrences, plasma cell proliferation results in a solitary lesion (solitary bone plasmacytoma or extramedullary plasmacytoma with minimal bone marrow involvement). Approximately 50% of patients with solitary plasmacytoma develop multiple myeloma within 10 years after the initial diagnosis. While back pain and compression fractures are commonly described presentations of multiple myeloma and plasmacytoma, cauda equina syndrome related to plasma cell infiltration is rare and clinical guidelines are limited. Herein, we present a rare case of a woman with acute cauda equina syndrome (CES) secondary to solitary bone plasmacytoma and multiple myeloma.
Highlights
Multiple myeloma (MM) is a hematological malignancy characterized by the abnormal proliferation of monoclonal plasma cells
magnetic resonance imaging (MRI) is the first line of investigation in a patient with red flag symptoms, such as those associated with spinal cord compression and cauda equina syndrome - lower back pain, bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and loss of sensory and motor function in the lower extremities
Recurrent solitary plasmacytoma at different sites may be treated with additional radiation therapy (RT), but patients with more extensive disease or early relapse may benefit from systemic therapy and/or autologous stem cell transplant (ASCT), as indicated for myeloma [11]
Summary
Multiple myeloma (MM) is a hematological malignancy characterized by the abnormal proliferation of monoclonal plasma cells. Plasma cell proliferation results in a solitary lesion (solitary bone plasmacytoma (SBP) or extramedullary plasmacytoma (EMP) with no evidence of systemic invasion and minimal bone marrow involvement). A 71-year-old female with a past medical history significant for hypertension and gastroesophageal reflux disease (GERD) presented to the Emergency Department (ED) with a six-week history of progressive back pain Her symptoms were associated with constipation, ataxia, saddle anesthesia, as well as bowel and bladder incontinence. The patient has tolerated chemotherapy well with minimal side effects and plans to start radiation treatments
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