Osteosclerotic Myeloma: A rare encounter!

Excerpt

A previously healthy 58 years old female, presented with fatigue and generalised weakness for past 6 months. During evaluation she was found to have severe anemia along with deranged renal parameters. (Hemoglobin—5.6 g/dL and creatinine of 1.9 mg/dL). Her peripheral smear showed marked rouleaux formation with normocytic anemia. Myeloma panel showed monoclonal spike of Ig G Kappa (1.9 g/dL). Bone marrow was difficult to aspirate and showed hemodiluted smears with few plasma cells (13% on differential count). (Figure 1B) Bone biopsy was showed marked osteosclerosis with thickened and anastomosing bony trabeculae leading to severe reduction in marrow spaces. (Figure 1A,C) The residual marrow spaces showed monoclonal plasma cells clustered in paratrabecular region (positive for CD 38, CD 138 and Kappa light chains) (Figure 1 D, E) PET/CT showed multiple osteosclerotic skeletal lesions in the right iliac bone, left femoral neck & thoracic vertebrae. There was no evidence of neuropathy, organomegaly, endocrinopathy or skin lesions on detailed evaluation. Table 1 elaborates on differences between Myeloma and POEMS syndrome which was closest differential in this case.

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