We report the case of a 75-year-old female patient with a history of hypertension and postoperative hypothyroidism (due to nodular goiter).
She presented in August 2008 with a 9-month history of fatigue, recurrent syncope and progressive dyspnea.
Within the study, severe normochromic normocytic anemia was investigated, with hemoglobin of 6.8 g/dL, leukocytes and platelets normal.
The ESR was 140 mm/h.
The suspicion of MM continued the study highlighting total proteins 14.6 g/dL, albumin 2 g/dL, corrected calcium 10.8 mg/dL, creatinine: 0.8 mg/dL, B2 microglobulin peak serum gamma globulin 3.2 mg.
Myelogram showed 25% adenocarcinomas and neutrophils.
The radiological series revealed lytic images in calcaneus and lumbar spine.
Therefore, the diagnosis of IgG MM was made, with prognostic indices of Durie Salmon IIIA and ISS of 3 points.
Treatment was initiated with hydration, pamidronate and melphalan/prednisone, with hypercalcemia.
She received treatment with melphalan/prednisone for 6 cycles and radiotherapy of the lumbar spine, highlighting in outpatient controls improvement in calcemia, but progressive pannitis and urinary infections a repetition.
In March 2009 he was hospitalized for pneumonia.
In November 2009 the patient presented with more bone pain and post-traction.
In addition, cutaneous manifestations are often neglected, with painful nodular lesions ranging from 1.5 to 2 cm in the scalp, left mandibular angle, neck and back.
A puncture of the lesions showed cellularity consisting exclusively of plasma cells, predominantly proplasmocytes.
Biopsy showed equally inactive plasma cells.
Due to disease progression, treatment was switched to thalidomide/dexamethasone, with no results.
The patient was referred to palliative care and died 2 months later due to infection in refractory myeloma.
