Atypical presentation of IgG multiple myeloma in a patient with hypercalcemia and kidney disease

A case report

Abstract

: Multiple myeloma is a hematological disorder characterized by the clonal alteration of malignant plasma cells that present associated organ dysfunctions. For its definition, the presence of > 10% of clonal plasma cells in the bone marrow or the presence of a monoclonal protein in serum or urine is necessary for the diagnosis and it may present a systemic condition such as hypercalcemia, renal failure, anemia and bone lesions. Background: Multiple myloma is a hematologic neoplasm characterized by the proliferation of monoclonal plasma cells with elevated production of a monoclonal immunoglobulin. With specific data such as hypercalcemia, kidney disease, unexplained anemia and bone disease. It arises from asymptomatic premalignant proliferation of monoclonal plasma cells that are derived from postgerminal B cells. It may be believed that myeloma most commonly evolves into a monoclonal gammopathy of undetermined clinical significance that progresses to smoldering myeloma, and finally symptomatic. The diagnosis must be made based on clinical, biochemical, morphological and imaging components. Treatment has been modified over the last 10 years in order to provide the best option based on age, physical condition, cytogenetic risk, and lines of treatment received. Clincial case: We present the case of a 64-year-old male patient with kidney disease, severe hypercalcemia, anemia, weight loss and bone pain of three months of evolution prior to hospital admission. Biochemically, hyperproteinemia, IgG elevation and serum protein immunofixation compatible with IgG monoclonal gammopathy were highlighted. Management was started with high-dose dexamethasone and thalidomide, the patient presented torpid evolution, to a state of refractory shock and died. Conclusions: The incidence of multiple mieloma in Mexico is little known, it has represented 1% of neoplasms, diagnosis continues to be a challenge, although therapeutic options have expanded in recent years, mortality is still high.

Fecha de recepción: 29/08/2022

Aceptación de originales: 09/05/2023