Clinical scenario:
A 65-year-old lady presented with complaints of generalized body aches, arthralgia, loss of appetite and weight of 2 years duration.
On examination, she was found to have pallor, severe malnutrition with BMI of 14kg/M2 , tenderness present over thoracic and lumbar vertebrae.
Investigations :
Labs : anemia hb 4.5 with mcv 102.7 ,mch 30.8
Esr 30, Platelet 45000 creatinine 2.2 with globulin 11.2 g/dl, albumin 2.6 .Corrected ca 10.
In view of hypergammaglobulinemia, anemia, and renal dysfunction, there was a suspicion of multiple myeloma.
X-ray skull and vertebrae were taken which showed punched out lesions in the skull and lytic lesions in vertebrae with fishbone appearance. Fig 1 and Fig2
Bone marrow aspiration showed plasma cells >50% of the marrow s/o multiple myeloma
Renal dysfunction improved with adequate hydration and correction of anemia was done via blood transfusions.
She is planned for chemotherapy .
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| Fig 1 Punched out lesions in skull |
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| Fig 2 Lytic lesions in Vertebra fish bone appearance |
Click to read Further Multiple myeloma
This case was contributed by
Dr. Rohit Rajeevan
Assistant Professor
Dept.of Medicine
Yenepoya Medical College Hospital
Mangalore Karnataka
