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A 70-year-old known multiple myeloma patient with complications

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  • Mr. Raihanul Kabir, 70 years old male, non-diabetic, normotensive diagnosed case of Multiple Myeloma for 4 months on the basis of-
    • clinical presentation
    • bone marrow morphology & other diagnostic evidence

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CBC

Hb 9 g/d ESR 112 mm/hr

Biochemistry

Creat 0.9 mg/dl Calcium 8.0 mg/dl Albumin 27 g/l LDH 308 U/L B2M 6.8

Protein electrophoresis

Monoclonal gammopathy (gamma 52.66%)

Immunofixation

Monoclonal band IgG Lambda

X-ray/CT/MRI

Paraspinal soft tissue mass L3 S2 biopsy- plasma cell myeloma

Partial collpase D11, D12

Bone marrow morphology

Increased number of typical and atypical

plasma cells including plasma blasts comprise

approximately (30% - 40%)

Trephine biopsy

Few atypical looking plasma cells compatible with plasma cell myeloma

Free light chain assay

Kappa 0.512 g/L

​

Lambda 11.245 g/L

​

Kappa:Lambda 0.05:1

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​

Patient recieved 4 cycle VTD protocol

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  • Pain & swelling of left lower limb
  • O/E-
    • Swelling of left lower limb upto knee joint,
    • overlying shiny skin, loss of hair,
    • not erythematous,
    • no ulceration,
    • left hip joint- painful, restrictd movement
    • tender,
    • pulse normally palpable,
    • no neurological deficit

​

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CBC

Hb 10.5 g/dl ESR 70

Biochemistry

Creatinine 0.96 mg/dl Calcium 8.0 mg/dl Albumin 32 g/l B2M 7.6

Protein electrophoresis

Polyclonal gammopathy 27.12%

Immunofixation

IgG Lambda

X-ray?CT/MRI

Multiple Vertebral Lytic lesion

Abdomino-pelvic soft tissue mass (19×15×13 cm)

Bone marrow

Remission (3% plasma cell)

Free light chain assay

Kappa 0.441 g/L

​

Lambda 3.209 g/L

​

Kappa:Lambda 0.14:1

D- dimer

Raised

Duplex study lower

Left lower limb DVT

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Rx- Rivaroxaban

    • Outpatient management
    • Less requirement of monitoring

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Persistent soft tissue mass??

DVT?

Primary disease Mx?

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???

Kappa

0.512 g/L

Lambda

11.245 g/L

Kappa:Lambda

0.05:1

Kappa

0.441 g/L

Lambda

3.209 g/L

Kappa:Lambda

0.14:1