Central nervous system involvement in Multiple Myeloma-Diagnosis, treatment and outcome: A case report
Muhammad Uzair Ali1, Shafaq Maqsood1, Mahrukh Malik2
1Department of Medical Oncology, Jinnah Hospital, Lahore, Pakistan.
Abstract:
Multiple Myeloma is a clonal proliferation of plasma cells with bone marrow as the primary site of occurrence. Extramedullary multiple myeloma is uncommonly seen either at presentation or later during the course of the disease. Central nervous system involvement by multiple myeloma is an extremely rare entity with a dismal outcome. This case report focuses on a 45-year-old male who presented with bone aches. Investigation findings leading to the diagnosis included elevated calcium levels, lytic lesions on radiological examination and clonal plasma cells in bone marrow biopsy. During his treatment, the patient was given chemotherapy regimens containing Lenalidomide, Bortezomib, Cyclophosamide, and Prednisolone. Thereafter, he developed neurological complications (CNS myelomatosis), which resulted in his demise. The clinical presentation, diagnosis, treatment and outcome of this rare condition is detailed below.
Insights
Central nervous system (CNS) involvement in multiple myeloma is rare, often presenting with neurological complications. This case highlights a fatal outcome despite standard chemotherapy, emphasizing the challenges in managing advanced multiple myeloma.
Area of Science:
- Hematology
- Oncology
- Neurology
Background:
- Multiple Myeloma (MM) is a plasma cell malignancy primarily affecting bone marrow.
- Extramedullary MM and central nervous system (CNS) involvement are rare but severe complications.
Observation:
- A 45-year-old male presented with bone pain, hypercalcemia, lytic bone lesions, and bone marrow biopsy confirming MM.
- The patient received standard chemotherapy including Lenalidomide, Bortezomib, Cyclophosphamide, and Prednisolone.
Findings:
- Despite treatment, the patient developed neurological complications consistent with CNS myelomatosis.
- This progression led to a fatal outcome, underscoring the poor prognosis of CNS involvement in MM.
Implications:
- This case emphasizes the critical need for vigilance regarding neurological complications in multiple myeloma patients.
- Further research into novel therapeutic strategies for CNS myelomatosis is warranted to improve patient outcomes.
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