[Bacterial meningitis as first manifestation of a patient with multiple myeloma. A case report]
Sergio Gálvez-Acosta1, César Enrique Garnica-Camacho
1Servicio de Medicina Interna, Hospital General de Tijuana, Secretaría de Salud del Estado de Baja California, Tijuana, Baja California, México. sgalveza@hotmail.com.
Background:
Multiple myeloma (MM) is a plasma cell neoplasm characterized by clonal proliferation of plasma cells in the bone marrow and monoclonal protein in serum and/or urine in association to target organ damage. Infections are a frequent finding and they are multifactorial and presented mainly in the first months of diagnosis.
Clinical Case:
We reported the case of a 62 years old woman, with impaired alertness, drowsiness, fever, incoherent speech and meningeal signs, cerebrospinal fluid showed polymorphonuclear pleocytosis, hypoglycorrhachia, hyperproteinorrhachia, and Gram positive cocci, she received antibiotic treatment and improved until resolution of symptoms, however when conscious she referred paraplegia and back pain, anemia, lymphopenia, elevation of serum globulins, calcium and CRP. The bone marrow aspiration showed infiltration by plasma cells and the serum protein electrophoresis and immunofixation showed the presence of monoclonal gamma IgA lambda spike. Smears of cerebrospinal fluid was absent of plasma cells. The diagnosis of multiple myeloma stage III-A is established.
Conclusions:
Association between (MM) and infection is high and although rare as first manifestation of MM, should take focus and high suspicion in patients with suggestive manifestations not explained by the infection itself.
Insights
Infections can be an early sign of multiple myeloma (MM), a cancer of plasma cells. Prompt diagnosis is crucial, even if symptoms initially suggest infection alone.
Area of Science:
- Hematology
- Oncology
- Infectious Disease
Background:
- Multiple myeloma (MM) is a plasma cell neoplasm.
- Infections are common in MM patients, often multifactorial.
- Infections typically present early in the course of MM diagnosis.
Observation:
- A 62-year-old woman presented with altered mental status, fever, and meningeal signs.
- Cerebrospinal fluid analysis revealed infection; however, subsequent evaluation showed MM.
- The patient experienced paraplegia, back pain, anemia, and elevated inflammatory markers.
Findings:
- Bone marrow aspiration confirmed plasma cell infiltration.
- Serum protein electrophoresis identified a monoclonal IgA lambda spike.
- The diagnosis of stage III-A multiple myeloma was established.
Implications:
- Infections can be a rare but significant initial manifestation of multiple myeloma.
- High clinical suspicion is warranted for unexplained symptoms in patients with suggestive signs.
- Early recognition of MM, even when presenting as infection, is critical for timely management.
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