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Published January 13, 2021 | Version v1
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Reporte de caso: Lumbalgia aislada como presentación atípica de mieloma múltiple

  • 1. Medicina Interna, Hospital General Regional No. 72 "Lic. Vicente Santos Guajardo", Instituto Mexicano del Seguro Social. Estado de México, México.

Description

RESUMEN

Introducción: El mieloma múltiple (MM) es una entidad considerada dentro de las gammapatias monoclonales, que requiere cierta destreza diagnóstica para sospecharlo incluso cuando los síntomas/signos pudieran ser muy habituales en un primer contacto de atención sanitaria, pero que requiere de vigilancia estrecha.

Caso clínico: Se describe el caso de un masculino de 63 años, con antecedente de hiperuricemia asintomática y discectomía lumbar hace 2 meses, ingresa a piso de hospitalización en el servicio de Medicina Interna por presentar hemorragia digestiva alta por uso crónico de AINEs secundario a lumbalgia persistente de 6 meses de evolución. En sus laboratorios presentando lesión renal aguda que ameritó terapia de reemplazo renal, hipercalcemia, anemia normocítica normocrómica y lesiones óseas líticas, por lo que se realizan estudios de extensión, incluyendo electroforesis de proteínas y biopsia de medula ósea compatibles con diagnóstico de mieloma múltiple Durie Salmon IIIB.

Conclusión: La mortalidad del mieloma múltiple se encuentra asociado a un diagnóstico precoz y dictará el rumbo de la terapéutica a ofrecer, por lo cual obliga al reconocimiento temprano de los signos/síntomas y la implementación de abordajes clínicos adecuados.

Palabras Clave: lumbalgia; dolor óseo; mieloma múltiple; electroforesis.

 

 

ABSTRACT

Introduction: Multiple myeloma (MM) is an entity considered one of the monoclonal gammopathies, which requires a certain diagnostic skill to suspect it even when the symptoms / signs may be very common in a first health care contact, but which requires close monitoring.

Clinical case: We describe the case of a 63-year-old male, with a history of asymptomatic hyperuricemia and lumbar discectomy 2 months ago, admitted to the hospitalization room of Internal Medicine due to presenting upper gastrointestinal bleeding secondary to chronic use of NSAIDs for persistent low back pain of 6 months of evolution. In his laboratories presenting acute kidney injury that merits renal replacement therapy, hypercalcemia, normochromic normocytic anemia and lytic bone lesions, for which extension studies are performed, including protein electrophoresis and bone marrow biopsy compatible with the diagnosis of multiple myeloma Durie Salmon IIIB.

Conclusion: The mortality of multiple myeloma is associated with an early diagnosis and will dictate the direction of the therapy to be offered, for which it requires early recognition of signs / symptoms and the implementation of appropriate clinical approaches.

Keywords: low back pain; bone pain; multiple myeloma; electrophoresis.

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