Cauda Equina Syndrome as the Initial Presentation of Concurrent Plasmacytoma and Multiple Myeloma

Abstract

Multiple myeloma is a hematological malignancy characterized by an abnormal proliferation of monoclonal plasma cells. In some occurrences, plasma cell proliferation results in a solitary lesion (solitary bone plasmacytoma or extramedullary plasmacytoma with minimal bone marrow involvement). Approximately 50% of patients with solitary plasmacytoma develop multiple myeloma within 10 years after the initial diagnosis. While back pain and compression fractures are commonly described presentations of multiple myeloma and plasmacytoma, cauda equina syndrome related to plasma cell infiltration is rare and clinical guidelines are limited. Herein, we present a rare case of a woman with acute cauda equina syndrome (CES) secondary to solitary bone plasmacytoma and multiple myeloma.

Successful BCMA CAR-T Therapy for Multiple Myeloma With Central Nervous System Involvement Manifesting as Cauda Equina Syndrome—A Wandering Road to Remission

“…Accordingly, he received 7 cycles of local radiation combined with 15 cycles of chemotherapy (3 cycles of bortezomib + dexamethasone, etoposide, doxorubicin, cisplatin (DEAP); 10 cycles of melphalan, cyclophosphamide, and prednisone (MCP); and 2 cycles of dexamethasone, etoposide, cyclophosphamide, cisplatin (DECP). At that time, the patient achieved complete remission (CR) in bone marrow confirmed by morphological examination and flow cytometry, as well as negative serum and urine immunofixation, while the extramedullary lesion showed only partial regression shown by PET-CT. Four months later, he complained of pain and weakness in bilateral lower limbs accompanied by urinary incontinence and was diagnosed with secondary CES, which is a rarely reported complication of MM ( 20 ). He was therefore enrolled in BCMA CAR-T therapy trial (Chictr.org.cn, ChiCTR1800017404, details regarding the design of this trial are accessible at ) after the approval by the ethics committee of the First Affiliated Hospital of Zhejiang University.…”

Solitary bone plasmacytoma of the tibia presenting as chronic osteomyelitis: A rare case report and literature review

“…[ 2 ] The current guidelines provided by the International Myeloma Working Group define SBP as biopsy-confirmed plasmacytosis in bone or soft tissue in the context of normal bone marrow and skeletal examinations (except for primary isolated lesions). [ 3 ] Chronic osteomyelitis is associated with avascular bone necrosis and sequestrum (dead bone) formation. [ 4 ] However, osteomyelitis complicated with plasmacytoma is extremely rare.…”