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A Very Rare Presentation Of A Common Disease
Poster Title: A Very Rare Presentation Of A Common Disease
Submitted on 12 Oct 2020
Author(s): Abdulfatahi Abdulmumeen, Beniel Vincent
Affiliations: Northampton General Hospital
This poster was presented at Virtual BIR Annual Congress 2020
Poster Views: 1,400
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Poster Information
Abstract: Background: Myeloma is an haematological malignancy due to abnormal proliferation of plasma or lymphoplasmacytic cells¹. Major clinical features include bone pain, anaemia, hypercalcaemia, renal failure and an increased risk of infections² . Myeloma is characterized by multiple destructive lytic lesions of the skeleton predominantly involving vertebral column, ribs, skull, pelvis and femoral bones³.

Case summary: A 96 y.o man who presented with left arm weakness upon waking up in the morning. He was diagnosed and managed for Right LACI stroke. CT brain done at presentation showed left clivus lytic lesion of unknown cause (likely malignancy). This lesion is an unusual finding which led to further investigations including brain MRI, CT chest, Abdomen and Pelvis, tumour markers and myeloma screen. The MRI confirmed right basal ganaglia infarct and the lytic lesion(see image)

The myeloma screen revealed elevated light chain myeoloma with raised B-2-Microglobulin Following haematology MDT, it was decided that based on his age and functional status, further investigations were deemed inappropriate. He was managed with 2 short courses of dexamethasone which showed reduction in the serum free light chains by almost half. Patient is currently being followed up for his stroke and myeloma.
Summary: We report a case of an incidental diagnosis of myeloma following a brain CT scan done in a patient that presented with stroke.

Myeloma can be asymptomatic and remain as an incidental finding. Though osteolytic lesions are common in myeloma, here we present the destruction of unilateral clivus as the only destructive presentation. Practitioners should consider myeloma as a differential even when osteolysis is seen in rare bony structures.
References: 1. Oxford handbook of clinical medicine 10th edition page 368
2..S. Vincent Rajkumar, Am J Hematol. 2016;91(7):719-734. doi:10.1002/ajh.24402
3. Dhaval Shah (MD), Medscape, multiple myeloma clinical presentation

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