Jafri Adeel A, K C Swarnima, Ioannou Elena, Philippananthan Johnson
Medical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, GBR.
General Medicine, University Hospital Lewisham, London, GBR.
Cureus. 2024 Jul 8;16(7):e64077. doi: 10.7759/cureus.64077. eCollection 2024 Jul.
Multiple myeloma (MM) typically presents with characteristic symptoms such as bone pain, hypercalcaemia, renal dysfunction, and anaemia. However, atypical presentations of MM, though rare, have been reported. These atypical presentations pose a diagnostic challenge due to their varied clinical manifestations, leading to potential delays in diagnosis and treatment initiation. We present the case of a 75-year-old woman who presented to the emergency department with a spontaneous haematoma on the dorsal aspect of her left hand and wrist. Despite lacking classical symptoms of MM, such as bone pain or renal dysfunction, laboratory investigations revealed abnormal findings, including high serum protein levels, low albumin, and abnormal immunoglobulin levels. Serum protein electrophoresis and immunotyping confirmed a diagnosis of MM, specifically the immunoglobulin-G lambda type. Additionally, urine protein electrophoresis further supported the diagnosis. Imaging studies did not show radiological evidence of myeloma. The absence of classical symptoms in our patient underscores the importance of considering MM in the differential diagnosis of atypical cutaneous presentations. Laboratory investigations, particularly serum protein electrophoresis and immunotyping, played a crucial role in establishing the diagnosis. The patient was treated with pulsed dexamethasone and plasmapheresis, followed by initiation of VCD chemotherapy protocol. Atypical presentations of MM present diagnostic challenges for clinicians. Our case highlights the importance of maintaining a high index of suspicion for MM, even in the absence of classical symptoms. Early recognition and diagnosis are essential for prompt management and improved patient outcomes. Clinicians should remain vigilant for atypical presentations of MM to ensure timely intervention and treatment initiation.
多发性骨髓瘤（MM）通常表现为骨痛、高钙血症、肾功能不全和贫血等典型症状。然而，MM的非典型表现虽罕见，但已有报道。这些非典型表现因其临床表现多样而带来诊断挑战，导致诊断和开始治疗可能延迟。我们报告一例75岁女性病例，她因左手背和手腕出现自发性血肿而到急诊科就诊。尽管缺乏MM的典型症状，如骨痛或肾功能不全，但实验室检查发现了异常结果，包括血清蛋白水平升高、白蛋白降低和免疫球蛋白水平异常。血清蛋白电泳和免疫分型确诊为MM，具体为免疫球蛋白G λ型。此外，尿蛋白电泳进一步支持了诊断。影像学检查未显示骨髓瘤的放射学证据。我们患者缺乏典型症状突出了在非典型皮肤表现的鉴别诊断中考虑MM的重要性。实验室检查，特别是血清蛋白电泳和免疫分型，在确立诊断中起了关键作用。患者接受了脉冲地塞米松和血浆置换治疗，随后开始VCD化疗方案。MM的非典型表现给临床医生带来诊断挑战。我们的病例强调即使在没有典型症状的情况下，对MM保持高度怀疑指数的重要性。早期识别和诊断对于及时管理和改善患者预后至关重要。临床医生应警惕MM的非典型表现，以确保及时干预和开始治疗。
