Case Report
PDF Zotero Mendeley EndNote BibTex Cite

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

Year 2019, Volume 3, Issue 12, 891 - 893, 03.12.2019
https://doi.org/10.28982/josam.652699

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.

References

  • 1. Rajkumar SV. Multiple myeloma. Curr Probl Cancer. 2009 Jan-Feb;33(1):7-64.
  • 2. Bolaman AZ. Diagnosis of multiple myeloma and criteria for response. Turkiye Klinikleri J Hem Onc Special Topics. 2008 July;1:1-4.
  • 3. 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.
  • 4. 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.
  • 5. 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.
  • 6. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratifi cation and response assessment of multiple myeloma. Leukemia. 2009 Jan;23:3-9.
  • 7. 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.
  • 8. 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.
  • 9. Kocaeli H, Köseoğlu BG, Bilgiç B. Mandibulada Multiple Myeloma (İki Olgu Sunumu) AÜ Diş Hek Fak Derg. 2005 Apr;32(2):135-45.
  • 10. 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.
  • 11. 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.
  • 12. Angtuaco EJ, Fassas AB, Walker R, Sethi R, Barlogie B. Multiple myeloma: clinical review and diagnostic imaging. Radiology. 2004 Apr;231(1):11-23.
  • 13. 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.
  • 14. 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.
  • 15. İliçin G, Biberoğlu K, Süleymanlar G, Ünal S (ed). İç Hastalıkları. 2rd ed. Güneş Kitabevi. 2003;1943-9.
  • 16. Türk Hematoloji Derneği Multipl Myelom Tanı ve Tedavi Kılavuzu. Sürüm 1. 02-Ekim, 2016;1-4.

Nadir bir olgu: Akut parapleji ile acil servise prezente olan yeni tanı multipl myelom

Year 2019, Volume 3, Issue 12, 891 - 893, 03.12.2019
https://doi.org/10.28982/josam.652699

Abstract

Kemik iliğinde monoklonal plazma hücrelerinin neoplastik proliferasyonu olan multipl myelom (MM), tüm kanserlerin %1’ini oluşturur. Bu yazıda ani gelişen her iki bacakta kuvvet kaybı ve yürüyememe şikayeti ile acil servise müracaat eden hastada tespit edilen ve nadir görülen yeni tanı MM literatür eşliğinde tartışmayı amaçladık. Sabah farkettiği her iki bacakta kuvvet kaybı ve yürüyememe şikayeti ile acil servise başvuran 42 yaşında erkek hastanın alt extremitelerinde 2/5 kuvvet kaybı ile beraber dengesini sağlamada bozukluk tespit edildi. Kan tetkiklerinde ürik asit 8,4 mg/dl, total protein 98,8 g/L, globülin 60,8 g/L olarak tespit edildi. Manyetik rezonans görüntülemede torakal (T)2 -T4 vertebralar arasında kitle izlendi. Kitle biyopsisi immünohistokimyasal çalışmada lezyona ait hücreler cluster of differentiation (CD)38, CD138, endomysial antibody, kappa ve lambda ile immün reaksiyon gösterdiği gözlendi. Serum IgA 0,27 g/L, IgM 0,28 g/L, IgG 44,36 g/L, beta-2 mikroglobulin 4,78 mg/L, lambda hafif zincir 0,230 g/L, kappa hafif zincir 5,25 g/L olduğu tespit edildi. Kitlenin biyopsi incelemesi plazma hücreli tümör, kemik iliği aspirasyon biyopsisi ise MM ile uyumlu ve atipik plazma hücreleri %52 olduğu tespit edildi. Hastada MM düşünüldü. Alt extremitelerde ani gelişen kuvvet kaybı şikayetiyle acil servise müracaat eden hastalarda ayırıcı tanıda plazma hücrelerinin neoplastik proliferasyonu olabileceği düşünülmelidir.

References

  • 1. Rajkumar SV. Multiple myeloma. Curr Probl Cancer. 2009 Jan-Feb;33(1):7-64.
  • 2. Bolaman AZ. Diagnosis of multiple myeloma and criteria for response. Turkiye Klinikleri J Hem Onc Special Topics. 2008 July;1:1-4.
  • 3. 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.
  • 4. 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.
  • 5. 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.
  • 6. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratifi cation and response assessment of multiple myeloma. Leukemia. 2009 Jan;23:3-9.
  • 7. 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.
  • 8. 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.
  • 9. Kocaeli H, Köseoğlu BG, Bilgiç B. Mandibulada Multiple Myeloma (İki Olgu Sunumu) AÜ Diş Hek Fak Derg. 2005 Apr;32(2):135-45.
  • 10. 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.
  • 11. 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.
  • 12. Angtuaco EJ, Fassas AB, Walker R, Sethi R, Barlogie B. Multiple myeloma: clinical review and diagnostic imaging. Radiology. 2004 Apr;231(1):11-23.
  • 13. 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.
  • 14. 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.
  • 15. İliçin G, Biberoğlu K, Süleymanlar G, Ünal S (ed). İç Hastalıkları. 2rd ed. Güneş Kitabevi. 2003;1943-9.
  • 16. Türk Hematoloji Derneği Multipl Myelom Tanı ve Tedavi Kılavuzu. Sürüm 1. 02-Ekim, 2016;1-4.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Case report
Authors

Sunay YILDIRIM
University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul.
0000-0003-4515-1358
Türkiye


Selman YENİOCAK (Primary Author)
University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul.
0000-0002-1124-396X
Türkiye


Mesut AYER
University of Health Sciences, Haseki Training and Research Hospital, Department of Hematology, Istanbul.
0000-0003-1977-0104
Türkiye


Adem AZ
University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul.
0000-0002-7204-6185
Türkiye


Muhammed ÖZDEN
University of Health Sciences, Haseki Training and Research Hospital, Department of Emergency Medicine, Istanbul.
0000-0003-1027-0015
Türkiye


Ahmet DEMİREL
University of Health Sciences, Okmeydanı Training and Research Hospital, Department of Emergency Medicine, Istanbul.
0000-0002-7905-5850
Türkiye

Supporting Institution Yok
Project Number Yok
Thanks --
Publication Date December 3, 2019
Published in Issue Year 2019, Volume 3, Issue 12

Cite

Bibtex @case report { josam652699, journal = {Journal of Surgery and Medicine}, issn = {}, eissn = {2602-2079}, address = {jsurgmed@gmail.com}, publisher = {Fatih BAŞAK}, year = {2019}, volume = {3}, pages = {891 - 893}, doi = {10.28982/josam.652699}, title = {A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias}, key = {cite}, author = {Yıldırım, Sunay and Yeniocak, Selman and Ayer, Mesut and Az, Adem and Özden, Muhammed and Demirel, Ahmet} }
APA Yıldırım, S. , Yeniocak, S. , Ayer, M. , Az, A. , Özden, M. & Demirel, A. (2019). A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias . Journal of Surgery and Medicine , 3 (12) , 891-893 . DOI: 10.28982/josam.652699
MLA 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" . Journal of Surgery and Medicine 3 (2019 ): 891-893 <https://jsurgmed.com/en/pub/issue/50441/652699>
Chicago 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". Journal of Surgery and Medicine 3 (2019 ): 891-893
RIS TY - JOUR T1 - A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias AU - Sunay Yıldırım , Selman Yeniocak , Mesut Ayer , Adem Az , Muhammed Özden , Ahmet Demirel Y1 - 2019 PY - 2019 N1 - doi: 10.28982/josam.652699 DO - 10.28982/josam.652699 T2 - Journal of Surgery and Medicine JF - Journal JO - JOR SP - 891 EP - 893 VL - 3 IS - 12 SN - -2602-2079 M3 - doi: 10.28982/josam.652699 UR - https://doi.org/10.28982/josam.652699 Y2 - 2019 ER -
EndNote %0 Journal of Surgery and Medicine A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias %A Sunay Yıldırım , Selman Yeniocak , Mesut Ayer , Adem Az , Muhammed Özden , Ahmet Demirel %T A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias %D 2019 %J Journal of Surgery and Medicine %P -2602-2079 %V 3 %N 12 %R doi: 10.28982/josam.652699 %U 10.28982/josam.652699
ISNAD Yıldırım, Sunay , Yeniocak, Selman , Ayer, Mesut , Az, Adem , Özden, Muhammed , Demirel, Ahmet . "A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias". Journal of Surgery and Medicine 3 / 12 (December 2019): 891-893 . https://doi.org/10.28982/josam.652699
AMA 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. 2019; 3(12): 891-893.
Vancouver 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. Journal of Surgery and Medicine. 2019; 3(12): 891-893.
IEEE S. Yıldırım , S. Yeniocak , M. Ayer , A. Az , M. Özden and A. Demirel , "A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias", Journal of Surgery and Medicine, vol. 3, no. 12, pp. 891-893, Dec. 2019, doi:10.28982/josam.652699

The DNS issue is resolved. jsurgmed.com and current publication are fully accessible.

To use the submission system properly, please use one of the following browsers, Chrome or Firefox, with the latest updates.
If you experience problems, it may be necessary to clear the browser cache and history; and disable blocker extensions, i.e., uBlock, of the browsers
Mobile phones are not recommended, please use a personal computer.