We report the case of a 32-year-old man without known drug allergies, with the only personal history of polyarticular rheumatism in childhood.
The patient was admitted to the emergency room with severe pain in the left hemithorax, which did not change with respiratory movements, postural changes, without cough or dyspnea, and without other accompanying symptoms.
Physical examination revealed a small nonspecific right laterocervical adenopathy, with hepatomegaly of about 3 cm from the costal margin, with no other relevant findings.
Presenting the following additional tests:
BASIC COMPLEMENTARY PRUES
Blood count and peripheral blood smear: Hemoglobin 13.3 g/dl, Platelets 281,000/ul, Leukocytes 8,800/ul with 23% segmented, 1% decayed, 2% metamyelocytes aspect
Biochemistry: Creatinine 1.2 mg/dl, Urea 52 mg/dl, (creatinine clearance 59 ml/min), total protein 10.8 g/dl, total calcium 9.8 mg/dl, normal rest.
Proteinogram: monoclonal peak in gamma band.
Coagulation: APTT 33.6 seconds, INR 1.35.
Basic urine culture: Positive protein with presence of mucin in the sediment.
Chest X-ray: Small nodular image calcified in the left lower lobe, probable calcified granuloma.
SPECIFIC PROVISIONS
Immunophenotype in peripheral blood: 45% of total white blood cell count has an abnormal immunophenotype: CD45+, CD38+, CD138+, CD56+, CD19-,23d,
Bone marrow aspirate: Presence of plasma cells in a proportion of 50% of the total cellularity, heterogeneous in size, predominantly intermediate-sized elements.
Common binucleated and trinucleated cells.
Bone marrow biopsy: Multifocal interstitial infiltrate of the medullary parenchyma due to plasmatic cells neutrophils IG-Kappa.
Medullary Plasmocytosis is 40-50%.
Amyloid material was negative.
Beta2-microglobulin: 7.3 mg/dl.
Bone series: No evidence of osteolytic lesions.
Serum immunoelectrophoresis: IgG 4.390 mg/dl, IgA 14.5 mg/dl, IgM 4.17 mg/dl. Serum immunofixation: Paraprotein IgG-Kappa.
Urine immunoelectrophoresis: Proteinuria of light chains (Bence-Jones) of 1.310 mg in 24 hours, for IgG-Kappa paraprotein and free Kappa light chains.
Serology HBV, HCV, HIV: negative.
Abdominal ultrasound: Hepatomegaly without focal hepatosplenic lesions.
There is no evidence of intra-abdominal lymphadenopathy or free intraperitoneal fluid, rest without alterations.
Diagnosis: The patient presents a clinical picture compatible with a multiple myeloma in his variant primary plasma cell leukemia.
Treatment: Given the patient's age, autologous peripheral blood progenitor cell transplantation was decided.
Induction chemotherapy was initiated with the C-VAD regimen.
