Case Of Multiple Myeloma Presenting Research Articles

Multiple myeloma presenting with acquired factor VIII inhibitor

An initial presentation of hematological malignancies associated with autoantibodies is not common, and there is only one documented case of multiple myeloma presenting with acquired FVIII inhibitor for multiple myeloma. In this paper, we describe a second case of multiple myeloma who presented with acquired FVIII inhibitor. A 43-year-old woman was referred to our hematology unit for anemia and an elevated erythrocyte sedimentation rate. Two months before her admission, she had undergone an operation at a local hospital because of ovarian cyst rupture complicated by severe postoperative bleeding. Because coagulation tests had revealed a prolonged partial thromboplastin time which could not be corrected by a mixing test and a decreased FVIII level, a diagnosis of acquired FVIII inhibitor had been made. The patient was hospitalized in our unit for further evaluation. The erythrocyte sedimentation rate was 110 mm/h, serum albumin level 2.5 g/dL, globulin level 5.6 g/dL, and C-reactive protein 47.8 mg/L (0-6). Serum IgG was high, and serum protein electrophoresis showed a monoclonal spike in the gamma region. An IgG-kappa paraprotein was identified by immunofixation of the urine and serum. X-ray films of the bones revealed lytic areas in the skull, pelvis, and lumbar vertebrae. Bone marrow aspiration showed normal cellularity with 40% plasma cell infiltration. The patient was diagnosed with the IgG kappa type of multiple myeloma associated with acquired FVIII inhibitor. In patients presenting with severe bleeding, autoantibodies against FVIII should be considered for the differential diagnosis of bleeding. Clinicians should be alert to the presence of rare underlying neoplastic diseases such as multiple myeloma, in patients with acquired FVIII inhibitor.

A case of multiple myeloma presenting as a bullous dermatosis

Multiple myeloma is a malignant plasma cell proliferative disorder that produces a monoclonal immunoglobulin protein. The skin involvement and the development of bullous disease are rarely seen features in multiple myeloma. We present a 55-year-old man with a longstanding, large, tense bullous eruption and hypertrophic scars over his body accompanied recently with weight loss and fatique. He had no response to the previous treatments, which included oral glucocorticoids and dapsone. Histologic examination of the lesions revealed subepidermal bullae, while no immunoflourescence staining was observed. In a further detailed labarotory examination, multiple myeloma was detected. After the treatment of multiple myeloma with chemotherapy, the lesions regressed. Patients with longstanding, recurrent, unusual bullous eruption should be investigated for the development of multiple myeloma.

Pseudohyperphosphatemia in a Patient with Multiple Myeloma

Hyperphosphatemia is an unusual manifestation in patients with multiple myeloma without a significantly reduced glomerular filtration rate. Serum phosphate may be falsely elevated when a large amount of paraproteins is present in the serum, because ultraviolet light absorbance is elevated with the phosphomolybdate ultraviolet assay, which is most commonly used for serum phosphate measurement. This pseudohyperphosphatemia can be confirmed by deproteinization of the serum of patients. We report a case of multiple myeloma presenting with spurious hyperphosphatemia revealing pseudohyperphosphatemia by deproteinization of serum using sulfosalicylic acid.

Multiple Myeloma Presenting in the Lacrimal Sac

To report an unusual case of multiple myeloma presenting with bilateral tearing secondary to lacrimal sac involvement. Observational single case report. An 83-year-old woman presented with bilateral tearing secondary to infiltrative lesions of the lacrimal sacs. A biopsy was performed; findings confirmed the diagnosis of multiple myeloma. The lacrimal sac fossa lesions responded to chemotherapy and local radiation. The patient subsequently developed multiple systemic recurrences, ultimately leading to her death. Multiple myeloma should be included in the differential diagnosis of lacrimal sac lesions.

A Case of Multiple Myeloma Presenting as Non-obstructive Jaundice Due to Plasma Cell Infiltration of the Liver

A Case of Multiple Myeloma Presenting as Non-obstructive Jaundice Due to Plasma Cell Infiltration of the Liver

Multiple myeloma presenting as fever of unknown origin

Background: Multiple myeloma (MM) itself is not considered to be responsible for fever and is not usually listed among the causes of fever of unknown origin (FUO). Methods: We report three cases of MM presenting with specific fever that we analyze in combination with the three previously published cases. Results: MM could easily be suspected in most, but not all, cases, emphasizing that bone marrow aspiration should be a part of ‘standard’ FUO investigations. All patients underwent extensive, sometimes potentially harmful, investigations. Conventional treatment of MM produced a sustained improvement in the temperature curve and inflammatory syndrome in all cases within a few months. Fever recurred during nearly all relapses. Six patients died, one after a disease course of more than 8 years. Conclusions: This series shows that MM may present as a FUO and that useless and hazardous investigations may be avoided given the possibility of specific fever in this disease. Chemotherapy must be considered without much delay after a reasonable work-up to eliminate any associated process, especially infections.

Multiple myeloma in an HIV-positive man presenting with primary cutaneous plasmacytomas and spinal cord compression

heavy chains and free kappa light chains. The CD4 cell count was 20/mm3. A biopsy specimen of the abdominal cutaneous nodules showed a tumoral proliferation in the dermis, consisting of round large cells with anisocaryosis of the nucleus containing numerous nucleoli. Immunohistochemical staining of the atypical plasma cells was positive for anti-IgA and κ sera (Fig 2). Epstein-Barr virus (EBV) DNA was detected by polymerase chain reaction (PCR) in the cutaneous biopsy specimen (the negative control for EBV PCR was performed on an EBV-negative B-lymphocyte cell line DG75). Immunofluorescence was negative for latency (EBNA2, LMP) and replication proteins (VCA, LMA), with a positive control performed on an EBV-positive B-lymphocyte cell line (B95). In situ hybridization was negative for EBER small RNA detection. A diagnosis of multiple myeloma was considered. Histologic examination and immunohistochemical staining of the skin biopsy specimen led to a diagnosis of secondary EMP secreting IgA κ. The skin involvement progressed rapidly, and a rapidly growing third nodule appeared in the left temporal region. Chemotherapy with melphalan and cortisone was initiated. After 3 cycles, the initial plasmacytomas had grown, and numerous other lesions had appeared on his arms, face, and chest. Osteolytic lesions appeared without hypercalcemia or renal failure. The patient died 3 weeks later. There is a broad spectrum of hematologic and immunologic abnormalities in HIV-1 infection. Although the incidence of B-cell–associated lymphomas is increased in HIV infection, fewer than 30 cases of multiple myeloma (MM) have been reported in persons infected with HIV.1-11 Unlike classic plasma cell tumors, the disease often has extramedullary involvement with unusual clinical presentation and a short latency period. Skin involvement is present in only 4% to 8% of HIVnegative patients11 with extramedullary plasmacytomas (EMPs). We describe a case of MM presenting with primary cutaneous plasmacytomas and spinal cord compression in a 53-year-old man positive for HIV.

Multiple myeloma presenting as a sellar plasmacytoma and mimicking a pituitary tumor: Report of a case and a review of the literature.

A case of multiple myeloma presenting as a plasmacytoma and mimicking a pituitary tumor is reported. The importance of recognizing the existence of plasmacytoma in the differential diagnosis of sellar and parasellar tumors is stressed, as it leads to important differences in management. The literature is reviewed. Patients presenting with plasmacytoma with symptoms of a pituitary adenoma have an average age of 58 years; the male to female ratio is 3:1; diplopia, headache, and progressive visual loss are the most important symptoms; third, sixth, and fourth cranial nerve palsies are the most common signs; and pituitary function is usually normal. CT scan of the sellar region is the imaging modality of choice; pathologically, light and electron microscopy are invaluable in making the correct diagnosis. Making the correct diagnosis allows further appropriate investigation for systemic disease and consequent management.

Multiple myeloma presenting as a hemorrhagic diathesis

A case of multiple myeloma presenting as a hemorrhagic diathesis is reported. Heretofore, reports of bleeding disorders seen with multiple myeloma have been rare in the dental literature. The classic features of the disease are reviewed, as well as the mechanisms of associated hemorrhagic dyscrasias.