Oral Manifestations of Malignant Immunoglobinopathy Hidden in Plain Sight - A Rare Case Report

Abstract

Rationale Radiolucent lesions over the angle–body region of the mandible are frequently difficult to diagnose but crucial to provide patient-centred care. Patient Concerns An elderly female presented with a painless slow-growing swelling over her left lower face for one year, radiographically appearing as a well-defined unilocular radiolucency over the left body of the mandible. Diagnosis Aspiration was negative, and biopsy was inconclusive. Further imaging, bone marrow biopsy, immune profile and serum electrophoresis confirmed the diagnosis of multiple myeloma. Treatment She was referred to Medical Oncology for chemotherapy of lenalidomide, bortezomib and dexamethasone regimen cycle that was repeated every 21 days. Outcomes There was no increase in swelling, and radiographically ‘punched-out’ lesions were reduced significantly. Take- Away Lessons Maxillofacial clinicians should be attentive to the oral manifestations of underlying disease, have a high index of suspicion and start the treatment promptly to increase chances of a favourable outcome.