Diplopia as the initial symptom of multiple myeloma in a patient with sarcoidosis.
Omid YazdanpanahJasleen KaurIrfan ShafiHousam A SarakbiPublished in: BMJ case reports (2020)
We present the case of a 45-year-old man with a known history of sarcoidosis who presented with double vision and headache. On examination, he was found to have left abducens and hypoglossal nerve palsy. CT and then MRI demonstrated extensive osseous lesions with a large expansile mass involving the clivus bone and sphenoid sinus. Laboratory data were remarkable for normocytic anaemia, low anion gap and elevated total protein which raised the suspicion for multiple myeloma. Subsequent protein electrophoresis and immunofixation illustrated monoclonal spike of IgG lambda present in the gamma zone. This was followed by a bone marrow biopsy that demonstrated plasma cells compromising around 80% of marrow cellularity. Left sphenoidal mass biopsy was consistent with plasmacytoma. Based on these findings, the patient was initially started on palliative radiation to shrink the intracranial tumour and is currently undergoing induction chemotherapy.
Keyphrases
- multiple myeloma
- bone marrow
- contrast enhanced
- case report
- induced apoptosis
- protein protein
- ultrasound guided
- magnetic resonance imaging
- fine needle aspiration
- computed tomography
- amino acid
- mesenchymal stem cells
- palliative care
- cell cycle arrest
- bone mineral density
- binding protein
- image quality
- ionic liquid
- electronic health record
- signaling pathway
- magnetic resonance
- machine learning
- small molecule
- advanced cancer
- postmenopausal women
- peripheral nerve
- iron deficiency
- bone regeneration
- chemotherapy induced