Revista nº 802

176 CASO CLÍNICO Actualidad Médica A C T U A L I D A D M É D I C A www.actualidadmedica.es ©2017.Actual.Med.Todoslosderechosreservados Non-secretory multiple myeloma presenting as pathological fractures: a diagnostic dilemma Abstract We present the clinical case of a 60 year-old woman who was admitted to our hospital referring a precor- dial pleuromechanic pain and was diagnosed with multiple bone fractures. A bone marrow biopsy gave the diagnosis of multiple myeloma and no monoclonal peak was detected, neither light chains in blood nor urine. The final diagnosis was non-secretory multiple myeloma and secondary spontaneous fractures. Non- secretory multiple myeloma represents only 3% of all multiple myelomas and has several characteristics that make it important to distinguish from other myelomas Resumen Presentamos el caso de una mujer de 60 años de edad que acudió a nuestro hospital por dolor precordial pleuromecánico y fue diagnosticada de fracturas óseas multiples. La biopsia de médula ósea dio el diagnós- tico de mieloma multiple y no se detectó pico monoclonal, ni tampoco cadenas ligeras en sangre ni orina. El diagnóstico final fue de mieloma múltiple no secretor y fracturas espontáneas secundarias. El mieloma múltiple no secretor representa solo el 3% del total de mielomas múltiples y tiene características peculiares que hacen necesaria su distinction del resto de mielomas. Emilio Guirao Arrabal 1 , María Francisca Parra Montoya 2 , Jesús González Oliveros 3 , María Montes Ruiz-Cabello 1 , Pedro Luis Carrillo Alascio 1 1 Internal Medicine Unit. Hospital La Inmaculada. Huércal-Overa, Almería, Spain 2 Radiology Unit. Hospital La Inmaculada. Huércal-Overa, Almería, Spain 3 Haematology Unit. Hospital La Inmaculada, Huércal-Overa, Almería, Spain Enviado: 12-11-2017 Revisado: 19-11-2017 Aceptado: 10-12-2017 Emilio Guirao Arrabal. Internal Medicine Unit. Hospital La Inmaculada. Avenida Ana Parra s/n. C.P. 04600. Huércal-Overa. Almería. España. E-mail: emilio.guirao@gmail.com Teléfono : +34 950029151 Palabras clave: mieloma múltiple; mieloma múltiple no secretor; biopsia de medulla ósea. Keywords: multiple myeloma; non-secretory multiple myeloma; bone marrow biopsy. Fracturaspatológicas como formadepresentacióndeunmieloma múltiplenosecretor: undilemadiagnóstico DOI: 10.15568/am.2017.802.cc03 Actual. Med. 2017; 102: (802): 176-177 INTRODUCTION Pathological fractures represent a diagnostic challenge by including in their differential diagnosis several types of solid tu- mors, hematological neoplasms, endrocrinometabolic patholo- gies, and also primary benign and malignant bone tumors and even bone infectious processes. We present a case of a patient with multiple pathological fractures who was diagnosed by bone marrow biopsy. CLINICAL CASE A 60-year-old woman, smoker of 20 cigarettes/day, without any previous disease, and no familiar history of interest, was ad- mitted to our hospital referring an intense, precordial, sudden on- set pleuromechanic pain. The patient was hemodynamically sta- ble, afebrile and breathing eupneic. At the abdominal palpation, she had epigastric pain, radiated from the sternum. The rest of examination was normal. She had a weight of 45 kg and a height of 1.55 m (BMI 18.7 kg/m 2 ). Blood tests results: haemoglobin 10.9 g/dL; leukocytes, pla- telets and basic clotting study were normal; biochemical urea 60 mmol/dL, calcium 10.9 mg/L, phosphorus 5 mg/L, total proteins 6.3 g/L, and intact PTH 8.6 pg/mL. Calcium and phosphorus in 24-hours-urine were both normal. The protein profile showed an elevation of alpha-1 and alpha-2 fractions, with reduced gamma fraction (IgG, M and A were low). Chest X-ray and computed tomography (CT) showed genera- lized osteopenia, and a left clavicle and medial 3 rd left rib fractu- res. Abdominal-CT also showed a vertical right sacral wing fracture (image 1). Tecnecium-99 metastable scintigraphy confirmed a fo- cus of tracer uptake in the left clavicle, but did not show any patho- logical deposition of activity attributable to a metastatic origin. A bone-marrow biopsy (right iliac) was taken and sample sent for pathological study, which gave the final diagnosis of mul-