A 49-year-old male patient with a history of hypothyroidism, later hyperDNA, hypertension, coronary heart disease and SLE was diagnosed in 1997 at 31 years of age (non-erosive arthritis of the wrist, erythema facial complement,
In October 2012 she consulted for pain in the right thigh.
Magnetic nuclear resonance (NMR) of the spine showed metastatic lesions of T12-L2-L4-L5, sacrum and ileum.
She was hospitalized for study and management of malignant hypercalcemia.
A CT scan of the neck revealed osteolytic lesions in the greater and lesser wings of the sphenoid bone, and in the sinus, it showed a recessive aspect.
Bone cystogram showed abnormal skeletal activity in the skull, sternum, vertebral arches, and pelvis suggesting secondary bone atypia.
Biopsy revealed fragments of nasal mucosa caused by monoclonal plasma cells compatible with plasmacytoma.
Blood protein electrophoresis with monoclonal band in beta 35.4%; decreased gamma region.
Immunoglobulin G (IgG) 3.930 mg/dl (normal 680-1.450 mg/dL), Immunoglobulin A (IgA) 140 mg/dl (normal count 83-407 g/dl)
Positive immunofixation for lambda chains.
Beta 2 Microglobulin 2.81 mg/dl. Myelogram showed plasma cells < 10% and patchy compromise of it.
Skull radiography with lytic lesions.
Symptomatic MM IgG light chains lambda was diagnosed at 46 years, according to the criteria of the International Myeloma Working Group.
Stage III A according to Durie and Salmon staging and stage II according to the International Atapification System (ISS) 7.8.
Cyclophosphamide 50 mg/day, thalidomide 100 mg/day, Dexamethasone 40 mg/day and Pamidronate 90 mg/month were initiated.
Due to the involvement of 40% body and posterior vertebral wall and risk of hip fracture, pelvic radiotherapy was indicated.
Complete response after 12 months of treatment.
Autologous bone marrow transplantation (ABMT) was programmed, not performed due to insufficient hematopoietic progenitors and secondary infectious complications.
In December 2014, a search in the bone cystonogram of activity showed increased multifocality, increased IgG, and protein electrophoresis with monoclonal component indicated second-line chemotherapy with Vincristine, doxorubicine 5 cycles.
Control of immunoglobulins showed IgA 169 mg/dL, IgG10 mg/dL, and IgM 16.8 mg/dL with monoclonal component beta of 8%.
In May 2016 she consulted for cervical volume increase.
A CT scan of the neck and chest revealed a retropharyngeal mass with vertebral involvement of C2, spinal canal and cervical adenopathies.
Biopsy was not performed due to malignant hypercalcemia, increased lupus activity and severe anemia with poor response to medical treatment and radiotherapy.
She died on June 2, 2016.
