A Case of Multiple Light Chain Multiple Myeloma Presenting with OVCF

Abstract

Background: Multiple myeloma is a hematologic malignancy characterized by the abnormal proliferation of bone marrow plasma
cells, which is often associated with the overproduction of monoclonal immunoglobulin or light chains. Osteolytic bone disease is a hallmark
of this condition. In this report, we present a case of delayed diagnosis of lambda light chain multiple myeloma, characterized by persistent
severe pain in the lower back and multiple fractures.
??Case Report: The patient visited eight hospitals due to persistent severe pain in the lower back for 17 months and was hospitalized nine
times. Multiple thoracolumbar vertebral compression fractures were identified through CT, MRI, and other relevant examinations conducted
five months after the onset of symptoms. A percutaneous vertebroplasty (PVP) was performed on five vertebrae. Following the procedure,
anti-osteoporosis medications, including denosumab, calcitonin, and teriparatide, were administered sequentially. Postoperatively, the patient's
pain was only temporarily alleviated, necessitating the daily use of oral analgesics. At the 17th month of the onset, bone marrow aspiration
and serum immunofixation electrophoresis were performed, leading to the final diagnosis of multiple myeloma, lambda light chain, DS stage
III, ISS stage III in group A. Following four cycles of chemotherapy, all indicators demonstrated complete remission (CR). By the sixth month
of chemotherapy, the patient's low back pain had significantly improved compared to before, allowing the patient to sit in a wheelchair.
??Conclusions: This case underscores the necessity for heightened vigilance regarding the potential for multiple myeloma in elderly patients who present with persistent severe pain and multiple lower back fractures, which may not solely be attributable to osteoporosis due to
age and bone mineral density loss. Specifically, when patients exhibit inadequate responses to anti-osteoporosis therapy, a thorough assessment should be conducted, integrating clinical symptoms, laboratory tests, and imaging findings. To establish a definitive diagnosis, additional
examinations, such as serum protein electrophoresis and bone marrow aspiration, are essential to rule out or confirm multiple myeloma, thereby preventing misdiagnosis or overlooked diagnoses.