No abstract

A 75-year-old woman was referred for investigation of severe neutropenia (neutrophil count 0.35 · 10 9 /l). Her only symptoms were of tiredness and arthralgia for some months. Physical examination was unremarkable. Further investigations showed no paraproteinaemia, Bence-Jones protein of 0.12 g/24 h, elevated serum light chains of 1.69 g/l and normal serum calcium and creatinine levels. Skeletal survey showed osteoporosis of T10 and T11 but no lytic lesions. Bone marrow examination showed 11% Gaucher-like cells with cytoplasmic inclusions (top panels). Subsequent staining with anti-CD138 (bottom left) and anti-kappa (bottom right) antibodies were strongly positive, confirming these to be atypical plasma cells loaded with immunoglobulin. A diagnosis of smouldering myeloma was made. Her neutrophil count recovered (to 3.57 · 10 9 /l) after cessation of treatment with enalapril. The patient continues to be observed.