A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias

Authors

Keywords:

Emergency medicine, Multiple myelom, Plasmacytome, Acute paraplegia

Abstract

Multiple myeloma (MM), neoplastic proliferation of monoclonal plasma cells in bone marrow, constitutes 1% of cancers. We discuss a rare case of newly diagnosed MM presenting to the emergency department with sudden strength loss in both legs and inability to walk, together with the current literature. Impaired balance and 2/5 strength loss in the bilateral lower extremities was determined in a 42-year-old man presenting due to weakness in both legs and inability to walk, noticed on waking in the morning. At blood tests, uric acid was 8.4 mg/dl, total protein 98.8 g/L, globulin 60.8 g/L. Magnetic resonance imaging revealed a mass between T2 and T4 vertebrae. At mass biopsy immunohistochemical investigation, lesion cluster of differentiation (CD)38, CD138, endomysial antibody, kappa and lambda cells exhibited immune reactions. Serum IgA was 0.27 g/L, IgM 0.28 g/L, IgG 44.36 g/L, beta-2 microglobulin 4.78 mg/L, lambda light chain 0.230 g/L, and kappa light chain 5.25 g/L. Mass biopsy revealed plasma cell tumor, with atypical plasma cells at 52%, which was compatible with MM at bone marrow aspiration biopsy. Neoplastic plasma cell proliferation should be considered for differential diagnosis in sudden strength loss in the lower extremities.

Downloads

Download data is not yet available.

References

Rajkumar SV. Multiple myeloma. Curr Probl Cancer. 2009 Jan-Feb;33(1):7-64.

Bolaman AZ. Diagnosis of multiple myeloma and criteria for response. Turkiye Klinikleri J Hem Onc Special Topics. 2008 July;1:1-4.

Günçag D. Hemolitik Anemiler. In: Dinçol G, Pekçelen Y, Atamer T, Sargın D, Nalçacı M, Aktan M, Beşışık SK, Eds. Klinik Hematoloji, İstanbul: Nobel Tıp Kitabevi. 2003:87-152.

Tesei F, Caliceti U, Sorrenti G, Canciullo A, Sabbatini E, Pileri S, et al. Extramedullary plasmocytoma (EMP) of the head and neck: a series of 22 cases. Acta Otorhinolaryngol. 1995 Dec;15:437-42.

International Myeloma Working Group. Criteria for the classifi cation of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003 Jun;121:749-57.

Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratifi cation and response assessment of multiple myeloma. Leukemia. 2009 Jan;23:3-9.

Oymak FS, Karaman A, Soyuer I, Karaman H, Gülmez I, Demir R, et al. Multipl Miyelomada Akciğer ve Göğüs Duvarı Tutulumu. Tüberküloz ve Toraks Dergisi. 2003 Jan;51(1):27-32.

Ersoy O, Sanlier T, Yigit O, Halefoglu AM, Ucak S, Altuntaş Y. Extramedullary plasmacytoma of the maxillary sinus. Acta Otolaryngol. 2004 Aug;124:642-44.

Kocaeli H, Köseoğlu BG, Bilgiç B. Mandibulada Multiple Myeloma (İki Olgu Sunumu) AÜ Diş Hek Fak Derg. 2005 Apr;32(2):135-45.

Önal MB, Kırçelli A, Civelek E. (2018). Solitary involvement of multiple myeloma in the upper thoracic spine, and anterior approach to thoracic region without full sternotomy: A case report. Journal of Surgery and Medicine. 2018 Sept;2(3):403-5.

Alkan Ö, Kızılkılıç E, Yıldırım T, Kasar M, Kızılkılıç O, Yeral M, et al. Multipl Myelomda İntrakranial Tutulum. Türk Nöroloji Dergisi. 2008 Oct;14(5):328-32.

Angtuaco EJ, Fassas AB, Walker R, Sethi R, Barlogie B. Multiple myeloma: clinical review and diagnostic imaging. Radiology. 2004 Apr;231(1):11-23.

Di Micco P, Di Micco B. Up-date on solitary plasmacytoma and its main differences with multiple myeloma. Exp Oncol. 2005 Mar;27(1):7-12.

Cervoni L, Celli P, Salvati M, Tarantino R, Fortuna A. Solitary plasmacytoma of the spine: Relationship of IgM to tumor progression and recurrence. Acta Neurochir (Wien). 1995 Sep;135(3-4):122-5.

İliçin G, Biberoğlu K, Süleymanlar G, Ünal S (ed). İç Hastalıkları. 2rd ed. Güneş Kitabevi. 2003;1943-9.

Türk Hematoloji Derneği Multipl Myelom Tanı ve Tedavi Kılavuzu. Sürüm 1. 02-Ekim, 2016;1-4.

Downloads

Published

2019-12-03

Issue

Section

Case Report

How to Cite

1.
Yıldırım S, Yeniocak S, Ayer M, Az A, Özden M, Demirel A. A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias. J Surg Med [Internet]. 2019 Dec. 3 [cited 2024 Mar. 29];3(12):891-3. Available from: https://jsurgmed.com/article/view/652699