Difficult To Diagnose Plasmocytoma With Atypical Clinical Presentation In An Older Patient: A Case Report

Abstract

INTRODUCTION AND OBJECTIVE: Plasmacytoma is a neoplastic proliferation of a plasma cell clone which produces monoclonal immunoglobulin. Solitary plasmacytoma of bone is defined by the presence of a single plasmacytoma in the absence of multiple osteolytic lesions or other findings compatible with multiple myeloma. We report an older patient with solitary plasmacytoma of the sternum associated with atypical clinical findings which complicated diagnosis and possible progression to multiple myeloma. CASE REPORT: A 74-year-old woman sought medical care due to mental confusion, tachydyspnea, and chest pain after a fall with blunt trauma to the anterior chest. During admission, the patient developed refractory hyponatremia, superficial thrombophlebitis in the left upper limb, periorbital cellulitis, endophthalmitis, and sternal osteomyelitis. Serum protein electrophoresis showed a polyclonal increase in gamma globulins. Biopsy result was compatible with plasmacytoma. A computed tomography scan showed no additional lesions. Progression was poor, with chronic renal failure exacerbated by probable tumor lysis syndrome, resulting in death. CONCLUSION: The present findings emphasize the importance of considering a diagnostic hypothesis of plasmacytoma/multiple myeloma in older patients with a set of varied clinical signs, such as anemia, renal failure, pathological fracture, and repetitive infections.

Keywords

• plasmacytoma
• multiple myeloma
• thrombophlebitis
• hyponatremia