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Oligosecretory multiple myeloma: a devastating presentation of a difficult diagnosis
  1. Ricardo Roque1,
  2. Laura Machado1,
  3. Duarte Flor2 and
  4. Francisca Cunha3
  1. 1Internal Medicine Department, Hospital and University Centre of Coimbra, Coimbra, Portugal
  2. 2Dermatology Department, Hospital and University Centre of Coimbra, Coimbra, Portugal
  3. 3Allergy and Clinical Immunology Department, Hospital and University Centre of Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Ricardo Roque; roque.jricardo{at}gmail.com

Abstract

A 57-year-old man with lumbar pain and fever was diagnosed with spondylodiscitis. Afterward, he acquired full paraplegia. Image studies showed a mass extending from D9 to the vertebral canal, plus numerous adjacent osteolytic lesions. Serum immunoelectrophoresis was normal, bone marrow had 0.5% of monoclonal plasmocytes, but D9’s biopsy found a plasmacytoma. Despite bone marrow aspiration results, skeleton osteolytic lesions made multiple myeloma (MM) a more plausible diagnosis, later confirmed by the biopsy. The absence of classical MM findings, alongside a medullary compression syndrome, suggested an oligosecretory MM, which was proved by an altered FLC essay. This delayed diagnosis, with multiple diagnostic misguiding leads, also presents rare IgA and lambda chains production and normal levels of uninvolved immunoglobulins. Oligosecretory MM can lead to an inaccurate and delayed diagnosis, with devastating consequences to patient’s morbidity and mortality. Therefore, FLC essay is essential in early assessment of potential MM patients.

  • malignant and benign haematology
  • oncology

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Footnotes

  • Contributors RR was mainly responsible for information selection and organisation, design conception and the draft preparation. Scientific research was conducted by FC and DF, and LM was in charge of assuring scientific correction. Patient’s follow up and clinical information acquisition was responsibility of all coauthors, was well as data interpretation, analysis and discussion. All authors revised and accepted the final manuscript. Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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