Myeloma Presenting as Paraparesis: A Case Report

Aim: To highlight the need to consider multiple myeloma as a probable diagnosis while evaluating a patient presenting with paraparesis and backache.
Presentation of Case: A 55 year old woman presented to a hospital in Calabar, Nigeria with complaints of low back pain and progressive difficulty in walking for three months. There was associated constipation and weight loss. She had received two units of whole blood prior to presentationon account of severe anaemia. Physical examination revealed marked cachexia, pallor, dehydration and oral candidiasis. There was bilaterallower extremity weakness and exaggerated deep tendon reflexes. Investigation revealed anaemia, elevated erythrocyte sedimentation rate, hypoalbuminemia and increased serum globulin. Corrected serum calcium and uric acid were also elevated. Radiographic studies revealed generalized osteopenia and gross reduction in vertebral body height of T6, T9, T11 and L2 with lytic lesions on the ribs and skull. She was managed with blood transfusions and cycles of systemic chemotherapy comprising of vincristine, adriamycin and dexamethasone and referred for radiotherapy.
Discussion: This case posed a diagnostic challenge. The presenting complaints suggested a compressive myelopathy which is more commonly caused by tuberculosis in our setting. Other considerations were benign or malignant tumours, HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) and neurolathyrism.
Conclusion: In the evaluation of a patient with paraparesis and backache, multiple myelomashould be considered. Failure to investigate for multiple myeloma will lead to delays in diagnosis and treatment. Early diagnosis can be made by demonstrating M proteins in either serum or urine, and showing more than 10% of these malignant plasma cells in the bone marrow.