A 54-year-old female patient with a history of hypertension and SLE diagnosed in 2006 at 45 years old with a renal biopsy that showed lupus nephropathy type IV, positive ANA 1/160 granular and aDNA positive.
She received induction with cyclophosphamide, prednisone and azathioprine, with inactive urine sediment and normal renal function.
In June 2010, the following stood out: erythrocyte sedimentation rate (HSV) 112 mm/h, aDNA negative, ANA positive 1/640, C3 120 mg/dL differential hemoglobin Creatinine 32.7 mg/dL complete
No clinical signs of lupus activity.
Because of persistently high ESR, a MM study was requested.
IgA quantification 4.110 mg/dL (normal 83-407 mg/dL), IgG 414 mg/dL (normal 680-1.450 mg/dL), IgM 48 mg/dL (normal 74-278 mg/dL).
Blood protein electrophoresis with monoclonal component in Alpha 2 and Beta, Albumin 3.5 g/dL.
Beta 2 Microglobulin 2.9 mg/dL
Radiography of long bones is normal.
Immunofixation was positive for IgA kappa.
In May 2011 Myelogram showed 47% of plasma cells and medullary myelomatosis.
It was diagnosed at 49 years asymptomatic MM IgA, according to the criteria of the International Myeloma Working Group.
Stage I according to Durie and Salmon staging and stage I according to ISS 7.8.
Two weeks after diagnosis, the patient had a vertebral fracture.
A biopsy of the thoracic vertebral fragments revealed a Plasmocytic Plasmocytoma.
With this diagnosis was reclassified as symptomatic MM stage III A, according to Durie and Salmon.
Treatment was initiated with 90 mg Pamidronate every month, 50 mg Thalidomide/day for 10 days and 40 mg/day Dexamethasone days 1-4 and 9-12 every 2 months completing 12 cycles.
In June 2011, due to a T8 fracture, the dorsal spine was fixed from T6 to T10.
In August 2011 she began radiotherapy on the dorsal spine and left sacroiliac joint.
Due to poor tolerance, she was switched to Melphalan 6 mg and Prednisone 60 mg for 7 days every 3 months completing 8 cycles and 2 years with Pamidronate.
One year of treatment in complete remission.
Control of immunoglobulins with IgA 425 mg/dL, IgG 1.180 mg/dL and IgM 67 mg/dL.
The patient refused ABMT and remained under follow-up.
