Peripheral arthritis as a form of atypical presentation of a multiple myeloma
Keywords:
Multiple Myeloma, Hemathology, Arthritis, Bone Marrow Cells, Rheumatology, Immunoglobulin lambda-Chains.Abstract
Multiple myeloma is a malignant neoplasm of plasma cells characterized by bone marrow infiltration and extensive skeletal destruction resulting in anaemia, pain in the bone and fractures. It represents 1% of malignant tumours and a little more than 10% of all malignant hemopathies.
Case report: We present the case of a 69-year-old patient, urban origin, with a personal pathological history of arterial hypertension and osteoarthrosis. He goes to the Internal Medicine service for presenting pain in the joints of both upper and lower limbs, of great intensity and long duration accompanied by fatigue that he relieves with analgesics. Complementary examinations showed haemoglobin figures of 105 g/L, erythrocyte sedimentation 131 mm/h, as well as Kappa and Lambda, increased with Bence Jones protein of 1,365 g/24h. Plain X-ray and plain CT scan of the chest ruled out lung neoplasia and bone lesions. The myelogram concluded with a diagnosis of multiple myeloma.
Conclusions: although osteolytic lesions, with the pain of the axillary skeleton, are the form of presentation of multiple myeloma, it does not exclude that the non-appearance of bone lesions, the presence of osteosclerosis or peripheral arthritis may be another form of presentation. In addition, the patient’s comorbidities are considered a clinical element to suspect atypical or uncommon presentations of the disease.
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1. Goldman-Cecil. Tratado de Medicina Interna. 25. ª Edición. Barcelona: Elsevier; 2016.
2. Agreda Pantoja A, Chao Pereira C, Hernández Barraza D, Roca Campaña V. Mieloma múltiple en paciente joven. Rev cubana med [Internet]. 2016 Dic [citado 12 Feb 2020 ] ; 55( 4 ): 319-323. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232016000400006&lng=es.
3. Valdivieso Herrera M, Vargas Ruiz L, Morales Luna D. Mieloma múltiple con osteoesclerosis difusa. Gaceta Mexicana de Oncología [Internet]. 2016 [citado 12 Feb 2020];15(3):177---180 Disponible en: http://dx.doi.org/10.1016/j.gamo.2016.05.011
4. Peña C, Rojas Ch, Rojas H, Soto P, Cardemil D, Aranda S, et al. Mieloma múltiple en Chile: pasado, presente y futuro del programa nacional de drogas antineoplásicas (PANDA). Revisión de 1.103 pacientes. Rev. méd. Chile [Internet]. 2018 Jul [citado 12 Feb 2020 ] ; 146( 7 ): 869-875. Disponible en: http://dx.doi.org/10.4067/s0034-98872018000700869.
5. Farreras Rozman. Temas de Medicina Interna. 18va Edición. Barcelona: Elsevier; 2016.
6. Johana Sigcho A. Mieloma múltiple: revisión de literatura, a propósito de un caso. Rev. Salud Humana [Internet]. 2017 [citado 12 Feb 2020] ; 1(1): 51-60. Disponible en: https://pdfs.semanticscholar.org/1fa1/a089ef3971cdee66da4b6e3ecc089a3ed5cb.pdf?_ga=2.209840149.1487170614.1592821492-1297466926.1592821492
7. Díaz García JD, Parra Landázury NM, Venegas Fuentes A. Linfoma maligno enmascarado como mieloma múltiple. Rev Actual. Med. [Internet]. 2017 [citado 12 Feb 2020] ; 102(802): 173-175 Disponible en : https://doi.org/10.15568/am.2017.802.cc02
8. González Naranjo LA. Síndromes reumáticos paraneoplásicos. Iatreia [Internet]. 2011 Mar [citado 12 Feb 2020] ; 24( 1 ): 65-75. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-07932011000100007&lng=en
9. García Ramos AE, Vera Lastre OL. Síndromes reumáticos paraneoplásicos. Revista Alergia México [Internet]. 2012 Mar [citado 12 Feb 2020]; 59(2):72-78. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=38252
10. Harrinson. Principios de Medicina Interna. 19 Ed. Estados Unidos: McGraw-Hill Interamericana. Vol 2 Capitulo 136 Trastornos de las células plasmáticas edición 19. Disponible en: https://www.pdfdrive.com/harrison-principios-de-medicina-interna-19edicion-volumen-2-d158080294.html
11. Mendoza Sánchez D, Tinoco Valerio J. Mieloma multiple IgA, con colapso vertebral y escasas lesiones osteoliticas. Revista Médica Carrionica [Internet]. 2016 [citado 12 Feb 2020]; 3(2): [aprox. 1 p.]. Disponible en : http://cuerpomedico.hdosdemayo.gob.pe/index.php/revistamedicacarrionica/article/view/113
12. Bess Constantén S. Anuario Estadístico de Salud de Cuba. Rev Méd Electrón [Internet]. 2019 [citado: 22 Jul 2020];38(5). Disponible en: http://files.sld.cu/bvscuba/files/2020/05/Anuario-Electr%C3%B3nico-Espa%C3%B1ol-2019-ed-2020.pdf
13. Ramírez Vargas R, Vera Marmanillo V, Velazque Rojas L, Pari Caller CG. Mieloma múltiple asociado con hiperbetaglobulinemia en paciente cirrótico. Reporte de caso. Rev Cienc Salud [Internet]. 2019;17(3):132-140. Disponible en: http://dx.doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.8370
14. Escalona González SO, González Milán ZC, Vázquez González LA. Mieloma múltiple como presentación de enfermedad crónica terminal. Revista EsTuSalud [Internet]. 2020; 2(1). Disponible en: http://revistaestudiantil.ltu.sld.cu/index.php/revestudiantil/article/view/14
15. Roca Goderich. Temas de Medicina Interna. 5ta Ed. Tomo 3. La Habana: Editorial Ciencias Médicas; 2017.
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