A 60-year-old male was referred to our clinic with 5-month history of gradual but progressive weight loss, recurrent fever, anorexia, progressive fatigue, and generalized bone pains. Two months after the onset of these symptoms, he developed inability to walk. There was no associated sphincteric dysfunction or sensory loss. There was no history of chronic cough. At the time of presentation, significant examination findings were pallor, inability to walk, and general bone tenderness. X rays of the skull, thoracolumbar spine, and pelvis showed lytic lesions (). Blood film and bone marrow aspiration were essentially normal with <5% plasma cells reported in the bone marrow. Erythrocyte sedimentation rate, C reactive protein, and serum protein electrophoresis were normal and urinary Bence Jones protein was negative. Laboratory data are summarized in .\nA bone marrow trephine biopsy was done and showed osteosclerotic changes and focal scalloping with prominent osteoclastic activity. The marrow was moderately to markedly hypercellular and was densely infiltrated by a cellular infiltrate. The cells were mostly small cells with fairly condensed chromatin. They showed a variable amount of cytoplasm and there was a fair sized subpopulation of plasmacytoid lymphocytes.\nImmunohistochemistry showed positivity of CD138 (which strongly supports the diagnosis of plasma cell myeloma) and cyclin D1 (which is associated with cases of plasma cell myeloma with lymphoplasmacytic morphology and correlates with the presence of the translocation t(11;14)(q13;q32)).
The present case is of a 60 year old woman who initially presented with back pain. There was no history of trauma or history suggestive of any comorbid conditions.\nExamination revealed tenderness on right side of lumbosacral spine and right sacroilliac joint. Hip movements were normal.\nMRI scan showed wedge compression fracture of D6, D7, D9 & D10 vertebrae with areas of altered signal intensity involving right sided pedicle of D9 & D10 vertebrae compressing the thecal sac and dorsal spinal cord.\nEdema in dorsal spinal cord at D10 level was also noted.\nLab investigations revealed\nHemoglobin of 13g/dl,\nTotal Leukocyte Count of 10,890 and\nPlatelet count of 1.5 lac/cumm.\nESR =27mm/hr\nViral markers revealed HCV positive (incidental finding).\nHypercalcemia with a serum calcium level of 12.5g/dl.\nPBF shows normal blood picture with mild neutrophilia (75%) and no rouleaux formation.\nBone marrow aspiration and biopsy revealed plasmacytosis (>45%)\nSerum protein electrophoresis showed absence of M band with hypogammaglobulinemia.\nThe above patient meets the criteria laid down by the international myeloma working group and chronic leukemia myeloma task force.\nIt was also a diagnostic dilemma as other disorders such as secondary deposits, osteoporosis and hyperparathyroidism can present with a similar picture.\nOur patient did not undergo serum immunoglobulinfree light chain assay (FLC).\nNow patient is currently being managed on the lines of treatment of multiple myeloma.