Meena Durga Shankar, Bohra Gopal Krishana, Garg Mahendra Kumar, Purohit Abhishek, Kumar Deepak, Tripathi Swapnil
Department of Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Department of Pathology, All India Institute of Medical Sciences, Jodhpur, India.
Case Rep Emerg Med. 2020 Feb 8;2020:4746865. doi: 10.1155/2020/4746865. eCollection 2020.
We report the case of an 84-year-old female presented to us with acute onset altered sensorium. On investigation, neurological and infectious causes were ruled out. On further evaluation, her serum calcium was found elevated (15.07 gm/dl). The diagnosis of hypercalcemic encephalopathy was made with the possibility of multiple myeloma due to raised total protein and globulin levels. Serum electrophoresis, immunofixation, and bone marrow examination confirmed the diagnosis of multiple myeloma. The patient was treated with bortezomib, dexamethasone, and lenalidomide. After 1 week, she improved with normalization of serum calcium. Herein, we highlight hypercalcemia as an important cause of encephalopathy. As our report suggests, metabolic encephalopathy can be the first presentation in multiple myeloma.
我们报告了一例84岁女性患者，她因急性起病的意识改变前来就诊。经检查，排除了神经系统和感染性病因。进一步评估发现，她的血清钙升高（15.07克/分升）。由于总蛋白和球蛋白水平升高，诊断为高钙血症性脑病，并怀疑有多发性骨髓瘤的可能。血清电泳、免疫固定和骨髓检查确诊为多发性骨髓瘤。该患者接受了硼替佐米、地塞米松和来那度胺治疗。1周后，她的血清钙恢复正常，病情有所改善。在此，我们强调高钙血症是脑病的一个重要病因。正如我们的报告所示，代谢性脑病可能是多发性骨髓瘤的首发表现。
