Osório Rui Marques, Pina Sérgio, Salero Teresa, Coelho Margarida Viana, Sousa Domingos, Mendonça Catarina
Internal Medicine Department, Hospital de Faro, Centro Hospitalar do Algarve, Faro, Portugal.
Eur J Case Rep Intern Med. 2020 Jan 7;7(1):001360. doi: 10.12890/2020_001360. eCollection 2020.
Autoimmune diseases (AID) have been associated with a variety of lymphoproliferative disorders. Multiple myeloma (MM), one of the most common haematologic malignancies characterized by clonal proliferation of bone marrow plasma cells, has been associated with a range of autoimmune disorders. In this report, we described a case study of a patient admitted to our Internal Medicine Department for a bone marrow biopsy and myelogram due to a monoclonal peak observed by his general practitioner. However, at admission he presented typical giant cell arteritis (GCA) complaints, suggesting the coexistence of both diseases. The possible pathogenesis, as found in the literature, explaining the association will be discussed.
A relationship between AID and lymphoproliferative diseases, although rare, may occur and some studies suggest that the diagnosis of autoimmune disease has a negative impact on survival in MM patients.Bone marrow plasmacytosis can present a diagnostic dilemma, since it may be due to neoplastic or non-neoplastic conditions (that is, reactive plasmacytosis associated with AID, chronic infection, metastatic carcinoma, liver diseases and acquired immunodeficiency).Immunophenotyping in a myelogram or immunohistochemistry in bone marrow studies are useful in confirming a monoclonal plasma cell proliferation.
自身免疫性疾病(AID)与多种淋巴增殖性疾病有关。多发性骨髓瘤(MM)是最常见的血液系统恶性肿瘤之一,其特征为骨髓浆细胞的克隆性增殖,它与一系列自身免疫性疾病有关。在本报告中,我们描述了一例因全科医生观察到单克隆峰而入住我院内科进行骨髓活检和骨髓造影的患者病例。然而,入院时他出现了典型的巨细胞动脉炎(GCA)症状,提示两种疾病并存。将讨论文献中发现的解释这种关联的可能发病机制。
AID与淋巴增殖性疾病之间的关系虽然罕见,但可能发生,一些研究表明自身免疫性疾病的诊断对MM患者的生存有负面影响。骨髓浆细胞增多可能会带来诊断难题,因为它可能是由于肿瘤性或非肿瘤性情况(即与AID、慢性感染、转移性癌、肝脏疾病和获得性免疫缺陷相关的反应性浆细胞增多)。骨髓造影中的免疫表型分析或骨髓研究中的免疫组织化学有助于确认单克隆浆细胞增殖。