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Neuroanesthesia
Anesthesia and Pain Medicine 2009;4(1):43-46.
Published online January 30, 2009.
Extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever with respiratory failure : A case report
Hyoung Joon Chun, Hyeong Joong Yi, Ji Seon Jeong, Dong Won Kim, Jae Chul Shim, Keon Hee Ryu
1Department of Neurosurgery, Hanyang University College of Medicine, Seoul, Korea .
2Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea. dongwkim@hanyang.ac.kr
3Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea .
Abstract
Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.
Key Words: Myeloma, intracranial bleeding, laboratory findings, multiple myeloma
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