Karapetians Anthony, Bajaj Tushar, Valdes Amanda, Heidari Arash
1 UCLA-Kern Medical, Bakersfield, CA, USA.
2 Ross University, Miramar, FL, USA.
J Investig Med High Impact Case Rep. 2019 Jan-Dec;7:2324709619852760. doi: 10.1177/2324709619852760.
Multiple myeloma is defined as the neoplastic proliferation of plasma cells resulting in a monoclonal gammopathy. The classic presentation of a patient is someone who presents with bone pain, osteopenia, or new onset fractures. We present a case of multiple myeloma presenting as Evan's syndrome (ES). Evan's syndrome is autoimmune hemolytic anaemia with autoimmune thrombocytopenia. A 44-year-old female was referred from her primary physician to the hospital as laboratory testing revealed haemoglobin of 5 gm/dL. The patient reported a two-month history of fatigue and a sixty-pound weight loss. Laboratory results demonstrated autoimmune hemolytic anaemia, C3 positivity, elevated immunoglobulin (Ig)G, elevated lactate dehydrogenase (LDH), low haptoglobin, elevated reticulocyte count, elevated RDW-CV (red blood cell distribution width-corpuscular volume), positive direct Coombs test, thrombocytopenia, and proteinuria, all of which led to an underlying ES. The patient was started on intravenous steroids followed by oral steroids. A flow cytometry, serum protein electrophoresis, and cytogenetics were obtained. A bone marrow biopsy revealed multiple myeloma and she was started on Bortezomib treatment. We present the fifth reported case of Evan's syndrome and multiple myeloma.
多发性骨髓瘤被定义为浆细胞的肿瘤性增殖,导致单克隆丙种球蛋白病。患者的典型表现是出现骨痛、骨质减少或新发骨折。我们报告一例表现为伊文氏综合征(ES)的多发性骨髓瘤病例。伊文氏综合征是自身免疫性溶血性贫血合并自身免疫性血小板减少症。一名44岁女性因实验室检查显示血红蛋白为5克/分升,由其初级医生转诊至医院。患者报告有两个月的疲劳病史和体重减轻60磅。实验室结果显示自身免疫性溶血性贫血、C3阳性、免疫球蛋白(Ig)G升高、乳酸脱氢酶(LDH)升高、触珠蛋白降低、网织红细胞计数升高、红细胞分布宽度-细胞体积(RDW-CV)升高、直接抗人球蛋白试验阳性、血小板减少和蛋白尿,所有这些均提示潜在的ES。患者开始接受静脉注射类固醇治疗,随后改为口服类固醇。进行了流式细胞术、血清蛋白电泳和细胞遗传学检查。骨髓活检显示为多发性骨髓瘤,她开始接受硼替佐米治疗。我们报告了第五例伊文氏综合征合并多发性骨髓瘤的病例。