Potturi Pragna, Arora Jay Singh, Gaggar Payal, Raju D Sree Bhushan
Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.
Indian J Nephrol. 2022 Nov-Dec;32(6):621-624. doi: 10.4103/ijn.IJN_22_21. Epub 2022 Dec 1.
Multiple myeloma (MM) is usually a disease of the elderly and only less than 1% are young individuals below 35 years of age. Central nervous system (CNS) manifestations of MM are even rarer, the most common being leptomeningeal involvement. We report a case of a 35-year-old male who presented with a fever of 3 weeks duration associated with slurring of speech, nasal regurgitation, hearing loss, and decreased urine output. CNS examination showed IX, X, and XII cranial nerve palsies with right otitis media and bilateral mastoiditis with conductive hearing loss. Renal biopsy showed cast nephropathy. The kappa-lambda ratio was 18, with β2 microglobulin measuring 12 mg/L. Bone marrow showed 90% plasma cells, and skeletal survey had bony lytic lesions. He responded well to dexamethasone, bortezomib, and thalidomide. His renal functions returned to normal, and palsies have improved completely. This report shows that MM should be suspected even in young patients with classical features of myeloma and CNS involvement is very rare in MM.
多发性骨髓瘤（MM）通常是一种老年疾病，35岁以下的年轻患者不到1%。MM的中枢神经系统（CNS）表现更为罕见，最常见的是软脑膜受累。我们报告一例35岁男性，持续发热3周，伴有言语不清、鼻反流、听力丧失和尿量减少。CNS检查显示IX、X和XII颅神经麻痹，右侧中耳炎和双侧乳突炎伴传导性听力丧失。肾活检显示管型肾病。κ-λ比值为18，β2微球蛋白测量值为12mg/L。骨髓显示90%为浆细胞，骨骼检查有骨质溶解性病变。他对地塞米松、硼替佐米和沙利度胺反应良好。他的肾功能恢复正常，麻痹症状已完全改善。本报告表明，即使是具有骨髓瘤典型特征的年轻患者也应怀疑患有MM，且MM累及CNS非常罕见。
