Unusual Presentation Of Multiple Myeloma Research Articles

An Unusual Presentation of Multiple Myeloma

An Unusual Presentation of Multiple Myeloma

P-040: Unusual presentation of multiple myeloma with rapidly progressing lesions of the distal bones: about a case report

P-040: Unusual presentation of multiple myeloma with rapidly progressing lesions of the distal bones: about a case report

An unusual presentation of multiple myeloma

Multiple myeloma commonly presents as anemia, renal failure, bone pain, and infections. Presentation with epistaxis is extremely rare, and hence myeloma as the etiologic factor is seldom considered. We report the case of a patient who initially presented with recurrent epistaxis and then with myasthenia. It was only when he developed acute kidney injury 4 months after the initial presentation with epistaxis that a diagnosis of multiple myeloma was made.

Large Abdominal Mass: An Unusual Presentation of Multiple Myeloma

Large Abdominal Mass: An Unusual Presentation of Multiple Myeloma

MM-217: Successful Management of an Unusual Presentation of Multiple Myeloma without Transplantation

>A 45-year-old male presented to the ER with fatigue and severe chest, scapula, and shoulder pain. The blood test showed anemia (Hb=6 g/dL) and hypercalcemia (Ca+=10.9 mg/dL). A bone Marrow biopsy was consistent with MM. A PET scan was done and showed diffuse large bone tissue. He was diagnosed with IgA kappa MM. Induction of chemotherapy with bortezomib 1.3 mg/m2, thalidomide 200 mg, steroids 4 mg, and zoledronic acid 4 mg IV was initiated with a very good partial response after 2 cycles, with regression of the bone lesions. The patient refused to have an autologous stem cell transplant (ASCT). He completed the VTD protocols, and he was maintained on thalidomide 100 mg/day, dexamethasone, and zoledronic acid. After 8 months of maintenance, noting that the patient was not compliant, a new PET scan showed massive bone lesions and tissue lesions progression. Bone marrow aspiration and biopsy with protein electrophoresis and immunofixation were performed, confirming disease relapse. After a thorough discussion with the patient, we decided to start second-line treatment with KRD, carfilzomib 20 mg/m2, REVLIMID 25 mg/day 1–21, and dexamethasone 40 mg. A subsequent evaluation of response by PET scan was performed after 2 cycles showed VGPR. The patient still refusing the ASCT due to financial reasons. He completed 6 cycles of KRD and remained under maintenance on REVLIMID.

A RARE CASE OF PULMONARY PARENCHYMAL INVOLVEMENT OF MULTIPLE MYELOMA

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Multiple myeloma (MM) is a systemic disease primarily involving the bone marrow. In MM, the normal bone marrow is replaced by malignant plasmacytes, which produce monoclonal proteins and this disease process mainly involves the axial skeleton. MM constitutes about 1% of all malignancies and 10% of hematologic malignancies. Extra-medullary plasmacytomas form a small percentage of plasma cell tumors, and majority of which primarily occur in the head and neck. However, the occurrence of extramedullary disease is very uncommon in MM. Hereby, we present a case of unusual presentation of multiple myeloma involving lung parenchyma. CASE PRESENTATION: 64-year-old man diagnosed with metastatic disease of the lumbar spine, sacrum, and pelvis and was found to have multiple myeloma. He was treated with chemotherapy and ultimately underwent an autologous stem cell transplantation after 5 cycles of CY-BOR-D therapy. He was continued on Revlimid. His transplant was complicated by septic arthritis and recurrent osteomyelitis of the right fifth metatarsal bone and got treated. He started having shortness of breath with exertion, fatigue, dysarthria, increased drowsiness and his family felt that he was not acting right. These symptoms lasted for an hour. He was brought to the hospital. Initially there was concern of CVA but work up came out negative. Patient was noted to have a low-grade fever. His white count was low at 2900, hemoglobin 8.4. He had a CT angiogram performed, which was remarkable for multiple bilateral pulmonary nodules, which were new compared to his prior CTA and PET scan of last year. He was seen in consultation by his oncologist who raised the concern of possible malignancy; however, given the appearance and the unusual likelihood for myeloma to present in this fashion, opportunistic infection was also in consideration. His cryptococcal antigen, Aspergillus beta-D-glucan were negative. His blood cultures were negative. He had elevation in his free kappa light chains suggestive of multiple myeloma relapse. VATS procedure was done to obtain a biopsy to further characterize his lung nodules, results showed infiltrates of Plasma cell Myeloma. DISCUSSION: Pulmonary parenchyma is an uncommon site of extramedullary involvement in multiple myeloma. Looking at the presented case we recommend in appropriate scenarios clinical suspicion should be raised for multiple myeloma metastasis and biopsy in such patient is warranted. Presented case was diagnosed after we discovered the monoclonal plasma cells on VATS biopsy. CONCLUSIONS: Even after bone marrow transplant with immunosuppressive medications in lung parenchymal involvement suspicion of the metastatic process should be kept high and histopathological diagnosis should be considered since presentation can easily be confused with drug pneumotoxicity, infectious etiologies and other forms of DPLD and cause a delay in care. Reference #1: Vojnosanit Pregl. 2014 Jun;71(6):596-9. Myeloma multiplex with pulmonary dissemination. Terzić B, Maksić D Reference #2: Clin Respir J. 2017 Nov;11(6):1057-1059. Endobronchial plasmacytoma in patient with multiple myeloma. Sunnetcioglu A, Ekin S, Bayram I, Ekinci O, Bugday IB Reference #3: Br J Radiol. 2006 Jul;79(943):e25-7. Pulmonary and nodal multiple myeloma mimicking lymphoma. O'Sullivan P, Müller NL DISCLOSURES: No relevant relationships by Amnah Andrabi, source=Web Response No relevant relationships by Kashif Aslam, source=Web Response No relevant relationships by Thomas Fynan, source=Web Response No relevant relationships by Bindu Gandrapu, source=Web Response No relevant relationships by Preeyanka Sundar, source=Web Response

87 Fanconi’s Syndrome: An Unusual Presentation of Multiple Myeloma

87 Fanconi’s Syndrome: An Unusual Presentation of Multiple Myeloma

Backache could be an indication of multiple myeloma: An unusual case report

Unusual presentation of multiple myeloma (MM) poses a diagnostic dilemma. The objective of this case report is to document the unique presentation of MM and to highlight the importance of backache which could be the only indicator for the diagnosis of MM. Although a history of trauma in the past is present in this case, but there is no molecular basis/evidence to declare trauma as a risk factor for MM. It can be concluded that the patients with backache should be thoroughly investigated to rule out any possibility of malignant disease process.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.311-315

143 An Unusual Presentation of Multiple Myeloma

143 An Unusual Presentation of Multiple Myeloma

Proptosis with hemiplegia: Unusual presentation of multiple myeloma.

Proptosis with hemiplegia: Unusual presentation of multiple myeloma.

An Unusual Presentation of Multiple Myeloma with High Grade Fever and Loss of Consciousness

An Unusual Presentation of Multiple Myeloma with High Grade Fever and Loss of Consciousness

Intrasellar plasmacytoma: an unusual presentation of multiple myeloma

Intrasellar plasmacytoma: an unusual presentation of multiple myeloma

Multiple cranial nerve palsies: As first presentation of multiple myeloma with intracranial plasmacytoma

Compression of cranial nerves (CNs) by an intracranial plasmacytoma is considered to be an unusual presentation of multiple myeloma (MM). Here, we report a case of right 3 rd , 6 th , 9 th , 10 th and 12 th CN involvement, which emphasizes the fact that multiple CN palsy can be the first presenting feature of MM.

Multifocal bone infarctions in both knees: an unusual presentation of multiple myeloma

Multifocal bone infarctions in both knees: an unusual presentation of multiple myeloma

Unusual presentation of multiple myeloma

Unusual presentation of multiple myeloma

A Bone to Pick About Chest Pain

Chest pain is an extremely common presenting symptom that is usually related to a cardiac cause. This case illustrates an unusual presentation of multiple myeloma as a cause of atypical chest pain. This case presentation shows the importance of having a broad differential diagnosis while evaluating patients with atypical chest pain. It also illustrates the potential role of Tc-99m sestamibi imaging as a diagnostic modality in patients with multiple myeloma.

Intrasellar plasmacytoma: an unusual presentation of multiple myeloma

Plasmacytomas are unusual causes of a sellar mass. Occasionally, they can be misdiagnosed as a nonfunctioning adenoma because of radiological and clinical similarities. We reviewed the pertinent literature and discuss here in the light of an illustrative case of our own. A 70-year-old woman presented with a recurrent hypophysial mass. Initial diagnosis of a nonfunctioning pituitary adenoma was later overruled by a repeat biopsy, which showed a plasmacytoma. The tumor stained positively for CD138 and kappa light chain. Further studies confirmed the diagnosis of multiple myeloma. The patient was successfully treated with radiotherapy followed by systemic chemotherapy. Because they have different therapeutic implications, extramedullary plasmacytomas involving pituitary gland should be considered in the differential diagnosis of a nonfunctioning pituitary mass.

An unusual presentation of multiple myeloma: a case report

Multiple myeloma can occasionally manifest with joint disease. We report the case of an individual with a progressive bilateral carpal syndrome and a symmetrical severe seronegative polyarthritis and joint swelling. Investigations revealed an erosive seronegative inflammatory arthritis in association with bilateral carpal tunnel syndrome, anaemia, hepatic impairment and nephrotic-range proteinuria. Synovial fluid cytology demonstrated plasmablasts and multinucleated cells with products of chondrolysis. The diagnosis of multiple myeloma (with secondary amyloidosis) was made on serum protein electrophoresis and bone marrow biopsy.The relationship between myeloma and joint disease is discussed, highlighted by the presence in this case of all three pathogenic features associated with arthritis in myeloma patients- an erosive arthritis, carpal tunnel syndrome and an invasive tumoural arthritis.

A Young Female with Severe Acute Renal Failure: An Unusual Presentation of Multiple Myeloma.

A Young Female with Severe Acute Renal Failure: An Unusual Presentation of Multiple Myeloma.

Spinal epidural hematoma after a pathologic compression fracture: an unusual presentation of multiple myeloma

Background context Spinal epidural hematoma can result from traumatic and atraumatic etiologies. Atraumatic spinal epidural hematomas have been reported as an initial presentation of multiple myeloma. There are no other reports previously describing spinal epidural hematoma after a pathologic spinal fracture. Purpose To present the first reported case of a spinal epidural hematoma after a pathologic fracture and a very unusual initial presentation of multiple myeloma in a young patient. Study design/setting Case report. Methods A healthy asymptomatic 37-year-old male was struck in the head with a ball while playing soccer. Initial symptoms included severe back pain without neurologic symptoms. Complete motor paralysis developed over the next 24 hours in the lower extremities with a sensory level of T10. Magnetic resonance imaging evaluation of the spine revealed a T6 compression fracture with a dorsal T3 to T10 epidural hematoma. The patient underwent surgical T2 to T8 posterior spinal decompression with evacuation of the hematoma. Serum and urine electrophoresis and bone marrow biopsy were performed. Results The results of the electrophoresis revealed an immunoglobulin A monoclonal spike. The bone marrow biopsy was positive for plasma cell myeloma. Recovery of some motor function was noted in both lower extremities postoperatively. The patient was subsequently started on steroids and chemotherapy for myeloma. The patient has also undergone bone marrow transplant, and his myeloma is currently in remission. Conclusion This is the first reported case of spinal epidural hematoma after a pathologic spinal fracture. Also, this case represents an unusual initial presentation of multiple myeloma in a young patient.