Authors
P Baburaj1, Lincy Paul2, Harikrishnan M P3
1Department of Medicine, Jubilee Mission Medical College, Thrissur, Kerala
2PG student, Jubilee Mission Medical College Thrissur, Kerala
3PG student, Jubilee Mission Medical College Thrissur, Kerala
Abstract
Central Nervous System – normal higher mental functions, normal reflexes, Cardiovascular System – within normal limits, Respiratory System – within normal limits, Gastrointestinal system – no hepato-splenomegaly.
He was investigated outside in a tertiary care centre. Outside investigations were showing pancytopenia, ESR – 19 mm/hour, CRP – 2.3, S. PSA – 2.53, GGT – 38, S. Calcium – 10.1 mg/dl, S. Phosphorus – 3.7 mg/dl, Uric acid – 3.7 mg/dl, LDH – 154, Reticulocyte count – 2%, Serum electrophoresis – No M band. USG abdomen showed Grade II BPH, Grade I fatty liver, Right renal cortical cyst. MRI spine showed straighten-ing of lumbar spine, suggestive of paraspinal muscle spasm, Cervical spondylosis, Asymmetric disc bulge at L2-L3 level and bilateral grade I neural foraminal narrowing & grade II narrowing at L3-L4 level.
Investigations done in our centre: Hb – 10.6 g/dl, TC – 2280 cells/cumm, ESR – 62 mm/hr, platelet – 1,00,000 cells/cumm, DC – N56 L34 E1 M7, HCT – 31%, MCV – 93.4, MCH – 31.9, MCHC – 34.2, SGOT -21 mg/dl, SGPT – 11 mg/dl, Alkaline phosphatase – 128 mg/dl, S. Protein – 6.6 mg/dl, S. Albumin – 4.4 mg/dl, S. Globulin – 2.2 mg/dl RFT – within normal limits, S. Calcium – 10.3 mg/dl, S. Sodium – 138 mg/dl, S. Potassium – 3.9 mg/dl, Urine BJP – Negative, CPK – 102, S. Iron – 57, S. Ferritin – 779, TSH – 2.96, S. Vitamin B12 – low normal, 24 hour urine protein – 359, X ray skull –punched out osteolytic lesions, Periph-eral smear – Dimorphic blood picture, normocytic and macrocytic, mild leukopenia and thrombocytopenia, Bone marrow aspiration and biopsy was suggestive of multiple myeloma, Serum Electrophoresis showed hy-poproteinemia, no abnormal bands (figure 1). Immu-nohistochemistry CD 138 positive, Kappa is negative, Lambda light chain restriction, MUM1 positive –sug-gestive of multiple myeloma. Final diagnosis is non-se-cretory myeloma presenting as polymyalgia rheumatica.