Abstract
BackgroundMultiple myeloma is a very heterogeneous disease comprising a number of genetic entities that differ from each other in their evolution, mode of presentation, response to therapy, and prognosis. Due to its more chronic nature and cumulative toxicities that patients develop from multiple lines of treatments, a number of symptoms are associated with multiple myeloma. However, the mechanisms responsible for the relationship between these symptoms and multiple myeloma currently remain unclear.Case presentationAn 85-year-old Japanese woman exhibited the rare presentation of multiple myeloma (immunoglobulin kappa chain type) with leukocytoclastic vasculitis and eosinophilia. The serum level of interferon-γ was decreased; however, serum levels of interleukin-4, interleukin-5, interleukin-6, interleukin-10, and tumor growth factor-β levels were elevated. She received a bortezomib, lenalidomide, and dexamethasone regimen. After one course of the treatment, the cutaneous manifestation rapidly improved and laboratory tests showed decrease of eosinophil cell count. Serum concentrations of immunoglobulin G decreased and plasma cells in bone marrow decreased. The serum level of interferon-γ was elevated and serum levels of interleukin-4, interleukin-5, interleukin-6, interleukin-10, and tumor growth factor-β decreased.ConclusionsIt is the first case of leukocytoclastic vasculitis and eosinophilia in multiple myeloma that was associated with a T helper type 1/T helper type 2 imbalance and T regulatory cells, and was successfully treated with bortezomib, lenalidomide, and dexamethasone. The present case reinforces the value of early evaluations for paraneoplastic symptoms in order to reach a diagnosis and allow for the prompt initiation of appropriate treatments and achieve successful therapeutic management.
Highlights
Multiple myeloma is a very heterogeneous disease comprising a number of genetic entities that differ from each other in their evolution, mode of presentation, response to therapy, and prognosis
It is the first case of leukocytoclastic vasculitis and eosinophilia in multiple myeloma that was associated with a T helper type 1/T helper type 2 imbalance and T regulatory cells, and was successfully treated with bortezomib, lenalidomide, and dexamethasone
We describe the first case of Leukocytoclastic vasculitis (LV) and eosinophilia in MM that was associated with a Th1/Th2 imbalance and T regulatory cells (Treg) cells, and was successfully treated with bortezomib, lenalidomide, and dexamethasone (VRD)
Summary
To the best of our knowledge, this is the first case report of LV and eosinophilia associated with MM. An awareness of the possible paraneoplastic complications of MM is important for successful treatments with anti-myeloma therapy and the prolongation of survival. Authors’ information SO and MN are treating patients of hematological disorders in Japanese Red Cross Society Wakayama Medical Center. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Shifts in the therapeutic paradigm for patients newly diagnosed with multiple myeloma: maintenance therapy and overall survival. Author details 1Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. Author details 1Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. 2Division of Pathology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
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