Aggressive Plasma Cell Myeloma as an Underlying Cause of Paraparesis In an Unusually Young Male Patient

Abstract

Plasma Cell Myeloma, also called multiple Myeloma, is a haematological malignancy characterised by the proliferation of malignant plasma cells with an associated monoclonal paraproteinemia. The disease is described to have a median age of diagnosis in the 7th
decade of life and rare below the 4th decade. We report a case in which the patient was first diagnosed as having Multiple Myeloma at the age of 29 years. The patient had been having symptoms for at least 5 months prior to the diagnosis being arrived at. His earliest symptoms were non-specific: malaise, low grade fever, easy fatigability. These were followed by palpitations, recurring bipedal swelling, polyuria and two months later gnawing lower back pain. Shortly after, he experienced sudden inability to walk without support. The patient reported to us that he had visited a number of primary care facilities where he had full blood counts done as well as x-rays of the lumbosacral spine but was apparently told that apart from having moderate anaemia, his lumbo-sacral X-ray findings were not significant. At the last facility he visited before presenting to our hospital, he was told that he had severe anaemia due to
chronic kidney disease. At presentation, a careful review of his history together with his laboratory investigations which included a FBC, blood film comment, BUE/Cr, and X- ray of the thoracolumbosacral spine was suggestive of Multiple Myeloma. Hence with his first blood film comment which showed mild rouleaux formation a bone marrow aspirate was requested. An ESR had not been done. The
marrow showed plasma cell infiltration of 65%. Serum protein electrophoresis showed an M component of 8g/L while a serum free light chain assay revealed an increase of the lambda component of 8480 mg/L (normal: 5.71- 26.30). A repeat x ray showed lytic lesions in the pelvic girdle, spine, shoulders and sternum. Patient was started on oral and intravenous hydration, renal dialysis, Zoledronic acid, chemotherapy with Vincristine, Adriamycin, Dexamethasone and Thalidomide, physiotherapy and thoracolumbar bracing. Patient
responded well to treatment.