부산대학교 도서관

Threatened multiple myeloma (MM) presents with varied phenotypes, multiple spinal osteoporotic fractures with constitutional features suggest malignancy. Apparent IgG, IgA & IgM myeloma in serum electrophoresis along with the presence light & heavy chains tracks the diagnosis towards MM. Prevalence of Kappa & Lambda light chains or any of the other types of heavy chains is not uncommon. An insidious case presenting with multiple spinal fractures along with very high level of beta 2-microglobulin, to the tune of 5453 ng/ml with higher Kappa & Lambda light chains in serum along with classical clinical features warrants for myeloma but it makes the diagnosis frippery and creates a clinical dilemma when the case goes for dramatic recovery. A 62 year old, chronic type 2 diabetic, male patient presented with complaints of backache since 6 months. He developed pain in the back, insidious and gradually progressive. After primary investigations he was diagnosed with partial collapse of D5, D6, D12, L1, L4 vertebrae. T score -3.5, absence of M-Spike, high serum IgG, high urinary Kappa & Lambda light chains, high beta 2-microglobulin. Bone marrow aspiration from right Posterior Superior Iliac Spine (PSIS) showed normal cytology/non-specific, CT guided biopsy from D12 shows no evidence of any granulomatous/neoplastic lesion. Oftentimes, osteoporotic fracture presents with severe pain, no pain resolution with empirical treatment necessitates the point of care investigations and comprehensive work-up of the patient. This patient was evaluated for suspicion of vertebral collapse due to malignancy but all relevant investigations turned up negative and there was no evidence of any malignancy. Patient was diagnosed as a case of Osteoporosis and treatment was started, conservative, physiotherapy and mobilization. This case became curious because of its non-sine qua non findings and dramatic resolution advocating the diagnosis for uncommon variant of Beta 2-Microglobinemia with Light Chain Gammopathy.
P-082 Akila Prashant (1), Vivek Anand Ojha (1), Vibhu Bahl (2) (1) Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India, (2) Department [...]