背景:多发性骨髓瘤(MM)伴继发性淀粉样变性(AL)是一种罕见的克隆性浆细胞增殖疾病,导致多个器官和组织功能障碍。我们报告了一例吞咽困难是MM和继发性AL患者的首发症状。
方法:患者是一名73岁的女性,住进了我们的医院,因为进行性吞咽困难4个月,肢体无力1个月。
方法:骨髓涂片和病理诊断提示存在MM,二头肌肌病诊断提示AL。
方法:VCD方案包括在第1、8、15和22天剂量为1.9mg的硼替佐米,在第1、8和15天剂量为0.4g的环磷酰胺,以及在第1、8、15和22天剂量为40mg的地塞米松。患者同时接受包括抗感染治疗在内的综合治疗,增强心脏功能,和营养支持。
结果:血中M蛋白和尿蛋白均为阴性,表明骨髓浆细胞减少到2%。流式细胞术分析显示最小百分比为0.04%。因此,完全缓解.
结论:MM的临床表现范围广泛,二次损伤的症状引起了严重的不安,而髓外表现的非典型症状对诊断该病提出了挑战。
BACKGROUND: Multiple myeloma (MM) with secondary amyloidosis (AL) is a rare clonal plasma cell proliferation disease, which causes dysfunction of multiple organs and tissues. We report a
case of dysphagia as the first symptom in a patient with MM and secondary AL.
METHODS: The patient was a 73-year-old female, was admitted to our hospital, because of progressive dysphagia for 4 months and limb weakness for 1 month.
METHODS: The bone marrow smear and pathology diagnosis revealed the presence of MM, while the biceps myopathy diagnosis indicated AL.
METHODS: The VCD regimen consisted of bortezomib at a dosage of 1.9 mg on days 1, 8, 15, and 22, cyclophosphamide 0.4 g on days 1, 8, and 15, and dexamethasone at a dosage of 40 mg on days 1, 8, 15, and 22. The patient simultaneously received comprehensive treatment including anti-infective therapy, enhanced cardiac function, and nutritional support.
RESULTS: The M protein in the blood and urine protein were negative, indicating a reduction in bone marrow plasma cells to 2%. Flow cytometric analysis revealed a minimal percentage 0.04%. As a result, complete remission was achieved.
CONCLUSIONS: The clinical manifestations of MM exhibit a wide range, with the symptoms of secondary injury causing significant disturbing, while the atypical symptoms of extramedullary manifestations pose challenges in diagnosing the disease.