Gálvez-Acosta S, Garnica-Camacho CE

Language: Spanish
References: 16
Page: 531-535
PDF size: 96.60 Kb.

ABSTRACT

Background: Multiple myeloma (MM) is a plasma cell neoplasm characterized by clonal proliferation of plasma cells in the bone marrow and monoclonal protein in serum and/or urine in association to target organ damage. Infections are a frequent fi nding and they are multifactorial and presented mainly in the fi rst months of diagnosis. We reported the case of a 62 years old woman, with impaired alertness, drowsiness, fever, incoherent speech and meningeal signs, cerebrospinal fl uid showed polymorphonuclear pleocytosis, hypoglycorrhachia, hyperproteinorrhachia, and Gram positive cocci, she received antibiotic treatment and improved until resolution of symptoms, however when conscious she referred paraplegia and back pain, anemia, lymphopenia, elevation of serum globulins, calcium and CRP. The bone marrow aspiration showed infi ltration by plasma cells and the serum protein electrophoresis and immunofi xation showed the presence of monoclonal gamma IgA lambda spike. Smears of cerebrospinal fl uid was absent of plasma cells. The diagnosis of multiple myeloma stage III-A is established.
Conclusions: Association between (MM) and infection is high and although rare as fi rst manifestation of MM, should take focus and high suspicion in patients with suggestive manifestations not explained by the infection itself.

REFERENCES

1. Chou T. Multiple Myeloma: Recent Progress in Diagnosis and Treatment. J Clin Esp Hematopathol 2012; 52(3):149-159.

2. Paszekova H, Kryukov F, Kubiczkova L, Hajek R and Sevcikova S. High-Risk Multiple Myeloma: Different Defi nitions, Diferent Outcomes?. Clin Lymphoma Myeloma Leuk 2013;1-7

3. Rajkumar SV. Treatment of multiple myeloma. Nat Rev Clin Oncol 2011; 8:479-91.

4. Valkovic T, Nacinovic AD and Petranovic D. Prophylactic broad spectrum antibiotics as a new anti-myeloma therapy. Medical hypothesis 2013 xxxx

5. Bladé J and Rosiñol L. Complications of Multiple Myeloma. Hematol Oncol Clin N Am 2007; 21:1231-46

6. Costa D, Shin B and Cooper D. Pneumococcemia as the Presenting Feature of Multiple Myeloma. Am J Hematol 2004;77:277-281

7. Ludwig H, Miguel JS, Dimopoulos MA, et al. International Myeloma Working Group recomendatios for global myeloma care. LEukemia 2013; 1-12

8. Suzuki K. Current Rherapeutic Strategy for Multiple Myeloma. Jpn J Clin Oncol 2013; 43:116-124

9. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003;78:21-33.

10. Pasa S, Altinitas A, Cil Timucin, et al. Two cases of bacterial meningitis accompanied by thalidomide therapy in patients with multiple myeloma: is thalidomide associated with bacterial meningitis?. Int J Infect Dis 2009; 13: e19-22

11. Yassin M, Omri H, Al-Hijji I, et al. Fatal Strongiloides stercolaris hyperínfection in a patient with multiple myeloma. Braz J Infect Dis 2010; 14: 536-539

12. Butler S and Malone R. Neuroaspergillosis Leading to Blindness in a Patient with Multiple Myeloma. America Journal of Physical Medicine and Rehabilitation 2009; Visual vignette: 87

13. Bigaillon C, Pelletier C, Abdulaye I, et al. Pneumococcal meningitidis: a fatal complication of myeloma. Ann Hematol 2007; 86:381-383

14. Landgren O, Rapkin JS, Mellemkjaer L, Gridley G, Goldin LR, Engels EA. Respiratory tract infections in the pathway to multiple myeloma: a population-based study in Scandinavia. Haematologica 2006; 91:1697–700.

15. Lindqvist EK, Goldin LR, Landgren O, et al. Personal and family history of immune-related conditions increase the risk of plasma cell disorders: a population- based study. Blood 2011;118:6284–91.

16. Chamberlain MC and Glantz M. Myelomatous Meningitis. Cancer 2008; 112(7):1562-67.