Background
Multiple myeloma (MM) is hematological cancer characterized by the
growth of malignant plasma cells of B-cell lineage which are found in
the bone marrow and secrete immunoglobulins (Ig) [1, 2, 3], The
illness mostly affects the bones, although it can also affect the
lymphatic nodes and epidermis. MM is an incurable disease [3], which
is also one of the most prevalent cancers that affect the spine [4].
In France, approximately 5000 new cases are detected each year [2],
while in the United States, MM represents around 1.6 percent of all
malignant tumors and almost 10% of hematologic malignancies [1, 5,
6]. Males are somewhat more likely than females to have MM and
African-Americans are twice as likely as Caucasians to develop the
disease, The patient’s median age at the time of discovery is around 65
years old [1, 6]. Some of the most common clinical signs (seen in
80% of patients) are refractory pain, fracture, vertebral collapse, or
spinal cord compression due to bone lysis. Anemia, hypercalcemia, renal
dysfunction, recurring infections, and hyperviscosity are some symptoms
of its progression [2, 6, 7]. One of the pathognomonic and
diagnostic hallmarks of MM is bone injury, which appears as an
osteolytic bone disease (OBD) or osteopenia [7], OBD affects
approximately 90% of patients with MM [7, 8]. Because of that
injury in MM patients, imaging plays an important role in disease
management. Magnetic resonance imaging (MRI) has proven to be a useful
tool in the diagnosis of MM bone lesions [8]. Clinical,
radiographic, histopathologic, and laboratory findings are frequently
used to diagnose MM. Back pain, vertebral fractures, paresthesia, and
paresis owing to spinal cord compression are the most common symptoms of
axial skeleton metastases in symptomatic patients. Hypercalcemia can
develop from lytic bone lesions, and renal failure might manifest as
anemia and proteinuria. The International Myeloma Working Group (IMWG)
established calcium elevation, renal dysfunction, anemia, and bone
disease (CRAB) acronym to describe the clinical symptoms of MM and to
distinguish it from other plasma cell dyscrasias such as solitary
plasmacytoma [5]. For a long time, prednisone, melphalan, and other
corticosteroids were used to treat MM [9, 10], Proteasome inhibitor
medications like Velcade (bortezomib), in conjunction with dexamethasone
(the VD regimen), have been utilized to treat MM for the past 20 years.
Velcade (bortezomib) and dexamethasone were typically combined with
cyclophosphamide, adriamycin, or even thalidomide (VTD) to increase
efficacy [9, 10]. In this study, we report a case of MM which was
complicated with spinal cord metastasis.