Deri Bulgularý ile Taný Konulan Bir Multipl Myelom Olgusu

Multipl myelom; kemik iliðinde plazma hücrelerinin malin proliferasyonu olup, klinik spektrumu, sebebi bilinmeyen monoklonal gammapatiden plazma hücreli lösemiye kadar deðiþebilmektedir. Hastalarýn baþvuru þikayeti genellikle kemik aðrýlarý, patolojik kýrýklar ya da tekrarlayan infeksiyonlardýr. Multipl myelomda, hastalarda deride amiloid depolanmalarý da görülebilir. Primer sistemik amiloidoz olarak tanýmlanan bu form, hafif zincir amiloid fibrillerinin depolanmasýyla karakterizedir. Olgumuz, yüz, gövde, aðýz içi ve genital bölgede iki senedir giderek artan multipl asemptomatik sarýmsý papüllerle baþvurdu. Hafif kilo kaybý dýþýnda sistemik bulgusu yoktu. Rutin tetkiklerinde C reaktif protein yüksekliði dýþýnda patolojik laboratuar bulgusu olmayan hastanýn yapýlan ileri tetkiklerinde, histopatolojisi ve immunhistokimya bulgularý amiloidoz ile uyumlu geldi. Bunun üzerine istenen immunglobulin (Ig) G düzeyi yüksek, protein elektroforezinde Ig G monoklonal gamapati saptandý. Kemik iliði biyopsisi ile multipl myelom tanýsý koyuldu. Hasta, amiloidozun deri bulgularý ile taný konulan, asemptomatik bir olgu olmasý nedeniyle sunulmaktadýr.

A Case of Multiple Myeloma Diagnosed by Skin Lesions

Multiple myeloma, being a malignant proliferation of plasma cells in the bone marrow, has clinical spectrum varying from monoclonal gammopathy with unknown significance to plasma cell leukemia. The presenting symptoms have usually been bone pain, pathologic fractures or repeating infections. In patients with multiple myeloma, amyloid depositions may be seen in the skin. This form, defined as primary systemic amyloidosis, is characterized by light-chain amyloid fibril depositions. Our case applied with multiple, asymptomatic, yellowish papules localized on the face, trunk, oral and genital mucosa, gradually increasing during the last two years. He had no complaints, except for slight weight loss. In routine tests, the patient had no pathological laboratory findings, except high C-reactive protein levels. Further research revealed histopathologic and immunohistochemical findings consistent with amyloidosis. Upon these results, immunoglobulin G levels were measured and found high, and in protein electrophoresis, IgG monoclonal gammopathy was determined. The diagnosis of multiple myeloma is made by bone marrow biopsy. This patient is presented for being an asymptomatic case diagnosed by skin findings of amyloidosis.