Découverte fortuite d’une récivide myélomateuse lors d’une scintigraphie osseuse réalisée dans le cadre d’une suspicion d’algodystrophie

Abstract

We report the case of a 51-year-old patient with a history of multiple myeloma in remission after several courses of chemotherapy and an autologous transplant in April 2019, referred by the pain center of the hospital in December 2020 for the performing of a bone scintigraphy in the context of a suspected algodystrophy of the left upper limb, after surgery for a cervical disc herniation in September 2020. Early whole body acquisition following the injection of 630 MBq of 99mTc-sodium oxidronate demonstrated an intense hyperhemic mass in the left shoulder, associated with diffuse hyperemia in the rest of the left upper limb. Hybrid SPECT-CT imaging confirmed the presence of a large tissue density mass associated with major lysis of the left humeral head. There was also a diffuse reactive hyperfixation of the entire left upper limb as well as two unknow lytic lacunar frontal hyperfixing lesions. Faced with these results, the patient also underwent a PET-CT scan with 18F-FDG finding the large left humeral lesion as well as several hypermetabolic osteolytic lesions. The patient was finally hospitalized in internal medicine and presented for regional multidisciplinary meeting (RCP), which concluded in a myeloma recurrence with left humeral plasmacytoma. Although bone scintigraphy is not one of the examinations recommended in the assessment of myeloma (1,2), it has proven to allow the correction of the diagnosis and the detection of recurrence. 18-FDG-PET-CT was found in our case to be a more sensitive examination in the detection of myeloma lesions, allowing a more complete assessment of the disease and the detection of lesions that went unvisualized on bone scintigraphy.