Multiple myeloma associated with systemic lupus erythematosus

A case of systemic lupus erythematosus (SLE) complicated by multiple myeloma is presented; the lupus diagnosis was put together with the diagnosis of myeloma but the symptoms had commenced a few years before. The putative mechanisms underlying this unusual combination are discussed.     

Multiple myeloma associated with immune thrombocytopenic purpura

Thrombocytopenia in patients with multiple myeloma is usually due to chemotherapy or marrow replacement with myeloma cells. Two patients with multiple myeloma who fulfilled criteria for the diagnosis of immune thrombocytopenic purpura are presented. The etiologic and therapeutic implications of this unusual association are discussed.     

Multiple myeloma associated with systemic lupus erythematosus

A case of systemic lupus erythematosus (SLE) complicated by multiple myeloma is presented. The lupus diagnosis was established together with the diagnosis of myeloma but the symptoms had commenced a few years before. The putative mechanisms underlying this unusual combination are discussed.     

多发性骨髓瘤与乙型肝炎病毒感染的临床观察

目的 探讨多发性骨髓瘤（MM）患者乙型肝炎病毒（HBV）的感染状况及乙肝表面抗原（HBsAg）阳性MM患者的临床特点。方法 应用ELISA法测定196例MM患者以及48 697例健康体检者（对照组）的HBV标记物,PCR法测定HBV-DNA拷贝数。结果 196例MM 患者中HBsAg阳性者有5例（2.6％）,与对照组的3.4%比较差异无统计学意义（P>0.05）。5例HBsAg阳性MM患者的HBV血清学标记均为HBsAg、HBeAb、HBcAb三者阳性,其中2例HBV-DNA拷贝数＞1000,给予拉米夫定治疗。5例患者均给予抗MM治疗,未见HBV激活和肝功能异常。结论 HBV感染可能与MM发病无关,抗MM治疗对HBV的病毒激活及肝功能的影响可能不明显,仍有待于进一步研究。     

Multiple myeloma

Opinion statement Multiple myeloma (MM) is an incurable plasma cell dyscrasia that remains fatal. Despite efforts over the past 3 to 4 decades, the median survival of patients with MM does not exceed 3 to 4 years. Although patients receiving combination chemotherapy have higher response rates compared with those receiving oral melphalan and prednisolone, they have no survival advantage. High-dose chemotherapy followed by autologous stem cell transplantation has documented benefit over conventional treatment and is currently the accepted mode of treatment for symptomatic MM. Allogeneic transplantation is associated with high complete remission rates, but at the cost of high therapy-related mortality. Maintenance treatment with interferon-a shows benefit, albeit in a small fraction of MM patients. The use of bisphosphonates in patients with MM has clearly demonstrated benefit and reduced morbidity associated with bone disease. All of these measures have improved remission rates and survival, but all patients with MM ultimately relapse and succumb to their disease. Novel therapeutic strategies are therefore required to improve outcome of MM patients. The responses noted to thalidomide in MM are encouraging. Immune-based strategies, including both adoptive immunotherapy and vaccinations, are currently being investigated in the preclinical and clinical setting, with the goal of enhancing autologous and allogeneic anti-MM immunity for therapeutic applications.     

Type B lactic acidosis and metastatic breast cancer

Summary A case is presented of a patient with longstanding metastatic breast cancer whose condition suddenly deteriorated due to hypercalcemia and severe lactic acidosis which rapidly proved fatal. Postmortem examination showed no explanation for the lactic acidosis other than extensive metastatic disease. A review of the rare syndrome of malignancy-induced lactic acidosis is presented with particular emphasis on the 5 other cases reported in association with metastatic breast cancer. Theories of pathogenesis and management controversies are discussed.     

Multiple myeloma presenting with spinal cord compression

The clinical features, treatment, and course of 6 patients with multiple myeloma, who presented initially with spinal cord compression, are reviewed. These 6 represent 12% of all patients with myeloma seen at our institution since 1979. Eighty-three similar patients were identified from the medical literature. There are no patient characteristics predictive for this presentation. A higher than expected proportion of patents have clinically localized disease, but progression to myelomatosis is common. As these patients present without a known diagnosis of malignancy, a prompt, invasive diagnostic procedure and the immediate institution of definitive local therapy is mandatory. Despite such an aggressive approach, the prospect for significant return of neurologic function is poor. Survival does not appear to be different from that of other patients with myeloma. Unlike other malignancies, a presentation with cord compression is not inconsistent with long-term survival, although significant morbidity secondary to the resultant functional disability can be expected.     

Burkitt's lymphoma presenting with lactic acidosis and hypoglycemia - a case presentation

We present what appears to be the first reported case of lactic acidosis and hypoglycemia in an adult patient with Burkitt's lymphoma. Lactic acidosis and hypoglycemia are rare complications of non-Hodgkin's lymphoma (NHL) with only 26 and 8 previous reports, respectively. Two prior cases of Burkitt's lymphoma-induced lactic acidosis have been reported (one child, one adult), both in the absence of hypoglycemia. A 74-year-old man presented with right upper extremity swelling, pleural effusion and axillary lymphadenopathy. Thoracentesis and bone marrow studies revealed Burkitt's lymphoma. On the second day of his hospitalization he developed severe lactic acidosis (pH 7.29, lactate 15.8 mmol/L) and hypoglycemia (27 - 60 mg/dl) resistant to glucose infusions. Serum insulin, proinsulin and C-peptide levels were normal and insulin antibodies were negative. Insulin-like growth factors I and II were low, while thyroid and cortisol studies were normal. The patient's mental status became altered, care was withdrawn and the patient expired. An autopsy revealed significant tumor burden that appeared to spare the liver. An extensive review of the literature demonstrates that NHL-induced lactic acidosis is associated with a mortality rate of 73% at 1 month and 92% overall with the clinical course closely linked to the chemotherapeutic response of the tumor. Furthermore, in contrast to our patient, 90% of previously reported cases were associated with liver involvement.     

Hemophagocytic syndrome associated with multiple myeloma

Hemophagocytic syndrome (HPS) is an uncommon reactive disorder characterized by proliferation of histiocytes that actively engulf other hematopoietic cells causing cytopenia. It complicates several diseases including hematological neoplasias. We report the case of a 54-year-old woman who was admitted to our hospital with fever of unknown origin. Her clinical picture was characterized by renal failure, splenomegaly and pancytopenia. Findings on bone marrow examination showed HPS associated with multiple myeloma. A review of the literature revealed that only one case has previously been published.     

Iatrogenic lactic acidosis: association with hypertonic glucose administration in a patient with cancer

A case of lactic acidosis associated with the administration of hypertonic glucose to a patient with a bulky undifferentiated carcinoma is presented. Characteristic alterations in amino acid concentrations were observed during the period of lactic acidosis. Resolution of the metabolic abnormalities were seen with discontinuation of glucose infusion. Short-term glucose infusion in a 90 minute iv glucose tolerance test resulted in an increase in serum lactate and appropriate changes in serine, ornithine, taurine, alanine, and arginine despite normal hormonal responsiveness.     

Type B lactic acidosis,an uncommon paraneoplastic syndrome

A 67-year-old male presented with anasarca and persistent non-pruritic rash of lower extremities. Physical examination was positive for subcutaneous edema with a non-blanching rash of abdomen and lower extremities. Labs showed leukocytosis, lymphocytosis, anemia and thrombocytopenia. He also had acute kidney injury and high anion gap (AG) metabolic acidosis with elevated lactic acid (11.3 mg/dL). Computerized tomography (CT) of abdomen and pelvis showed hepatosplenomegaly, ascites and abdominal lymphadenopathy. Peripheral blood (PB) smear showed blastiod appearing lymphocytes. He was started on bicarbonate infusion due to persistent lactic acidosis (LA), however showed no significant improvement. He was started on IV dexamethasone on 3rd day of hospitalization based on preliminary result of peripheral picture which led to some improvement in LA. Following the confirmation of mantle cell lymphoma (MCL) on bone marrow (BM) biopsy and immunophenotyping, the patient started receiving VR-CAP regimen (bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone) which led to significant improvement in LA and leukocytosis. After discharge, he received further chemotherapy with resolution of the LA and normalization of blood counts. Restaging tests confirmed a complete remission with resolution of the skin rash, resolution of the pathological lymphadenopathy and hepatosplenomegaly on imaging, and absence of lymphoma on a repeat BM biopsy.