Case presentation
A 41-year-old male presented to the Department of Neurology with a
complaint of weakness in the lower extremities with a ⅖ strength,
uncontrolled sphincters, and a lack of reflexes. The patient was
diagnosed with MM 10 months ago and had myeloid infiltration with plasma
cells of more than 60% at the expense of Immunoglobulin G (IgG) Kappa.
The patient has received four rounds of Velcade® (bortezomib) 1.3 mg/m2
(milligram per square meter of body mass) on days 1,4, 8,11, and 22 +
Revlimid® (lenalidomide) 25 mg from day 1 until day 21 + dexamethasone
40 mg for 4 days [VRD] treatment, followed by an autologous
transplant, and the patient was in remission. The patient’s vital signs
and laboratory tests were normal, and the MRI of the dorsal and lumbar
columns showed a mass at the end of the spinal cord extending to
infiltrate the entire cauda equina from the level of the second dorsal
vertebra to the sacrum with a high suspicion of astrocytoma Fig. (1,2).
Cerebrospinal fluid (CSF) puncture showed that the patient had atypical
plasmatic infiltrates (Fig. 3). The immunophenotype of the CSF fluid
revealed that 38% of the cells were plasma cells, with a positive
cluster of differentiation 38 (CD38), syndecan-1 (CD138), ig kappa, and
Cluster of Differentiation 7 (CD7) cells in the fluid noting that the
patient was in remission; the bone marrow aspiration results illustrated
the existence of less than 5% of plasma cells and no monoclonal peak
was found in the peripheral blood sample (Fig.4). To prepare for
emergency irradiation, intrathecal methotrexate (IT MTX) was given five
times with a high dose of Dixon. Nevertheless, the patient passed away
directly after, therefore we were unable to track the patient’s progress
in this case.