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CASE REPORT
Successful treatment of central nervous system myeloma manifesting as cauda equina nodules with intrathecal chemotherapy, lenalidomide and dexamethasone
  1. Ray Mun Koo1,
  2. Philip Crispin1,2,
  3. Melissa Craft3,
  4. Shivendra Lalloo3
  1. 1Clinical Haematology Department, ACT Health, Canberra, Australian Capital Territory, Australia
  2. 2Australian National University, Canberra, Australian Capital Territory, Australia
  3. 3Medical Imaging Department, ACT Health, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Dr Ray Mun Koo, raymun{at}gmail.com

Summary

We report a case of central nervous system myeloma manifesting as cauda equina nodules, successfully treated with triple intrathecal (IT) chemotherapy, lenalidomide and dexamethasone. After presenting with multiple plasmacytomas which led to a diagnosis of non-secretory myeloma at age 56, the patient underwent multiple episodes of treatment for relapsing myeloma over a 7-year period. In March 2017, he presented with declining gait over a month with bilateral hip flexion weakness, absent lower limb reflexes and dorsal column loss. MRI of the spine revealed multiple enhancing cauda equina nodules at L1–L3. Cerebrospinal fluid (CSF) examination confirmed a clonal plasma cell population and disease was not found elsewhere. He was treated with radiotherapy, IT and intravenous methotrexate and cytarabine. However, repeat lumbar puncture revealed persistent disease. Clearance of CSF plasma cells was achieved with two times a week IT cytarabine, methotrexate and dexamethasone. He was started on lenalidomide and dexamethasone with no evidence of disease progression at 12 months.

  • haematology (incl blood transfusion)
  • neuroimaging
  • haematology (drugs and medicines)
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Footnotes

  • Contributors PC was the patient’s primary treating physician. The identification of the cauda equina nodules on CT and subsequently MRI was by MC and SL, respectively. The corresponding author RMK was assisting the treating physician PC in the treatment of the patient. The write-up of this case report was by both PC and RMK.

  • 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.

  • Patient consent Obtained.

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

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