Case 8-2015

Abstract

Pr esentation of C a seDr. Naina Rastalsky (Medicine): A 68-year-old man with multiple myeloma was seen in the rheumatology clinic of this hospital because of increasing skin tightness, joint pain, and swelling of the hands and feet.The patient had been well until 2 years before this presentation, when anemia was noted on routine examination at another hospital. During the next 7 months, endoscopic and colonoscopic screening examinations were negative. Pathological examination of a bone marrow-biopsy specimen and aspirate revealed 30% plasma cells; flow-cytometric studies revealed an IgG lambda M component. A diagnosis of multiple myeloma was made. Skeletal radiographs reportedly revealed multiple lytic lesions. Lenalidomide, bortezomib, and dexamethasone were administered, followed by cyclophosphamide. Nine months before this presentation, the patient was admitted to this hospital; melphalan hydrochloride was administered, and autologous stem-cell transplantation was performed. Results of follow-up studies were consistent with complete remission.Three months before this presentation, the patient was seen by an orthopedist at this hospital for evaluation of low-back pain of 1 year's duration. Magnetic resonance imaging (MRI) of the lumbar spine, performed after the administration of intravenous gadolinium, revealed multilevel degenerative changes, multiple enhancing lesions in the lumbar spine and left iliac bone, and compression fractures of the first and second lumbar vertebrae, findings consistent with the history of multiple myeloma.Two months before this presentation, swelling and pain in the hands occurred, followed by pedal edema, tightening of the skin of the hands and feet, and diffuse hyperpigmentation on the trunk, arms, and legs. Maintenance therapy with lenalidomide was begun, but it was stopped during the first cycle because of worsening symptoms.Diffuse joint pain occurred and hyperpigmentation increased. One month before this presentation, on evaluation in the outpatient cancer center of this hospital,

Systemic Sclerosis and Malignancy: A Review of Current Data

“…Wigley et al [ 56 ] reported a case of SSc presenting with SRC in a 68-year-old man with MM who had been treated and had entered remission.…”