Silent Hyperviscosity: Diagnostic Challenge in Myeloma
DOI:
https://doi.org/10.37135/ee.04.25.09Keywords:
multiple myeloma, hyperviscosity syndrome, plasmapheresis, pathological fractures, lenalidomideAbstract
A 62-year-old man was presented with pathological fractures of the spine and hip, admitted for pneumonia and severe anemia (hemoglobin 6.4 g/dL), who developed progressive neurological deterioration. Studies revealed hypercalcemia, hyperproteinemia (12.29 g/dL), elevated IgG (9,970 mg/dL), and lambda light chains in urine (161.8 mg/dL). Bone marrow biopsy confirmed IgG/Lambda multiple myeloma with hyperviscosity syndrome (HVS). Emergency plasmapheresis (3 sessions) improved neurological symptoms by 50 %, followed by chemotherapy (lenalidomide/dexamethasone), zoledronic acid, and transfusional support. At discharge, hemoglobin was 8.4 g/dL with normalized calcium, requiring outpatient follow-up. This case highlights the importance of suspecting multiple myeloma in patients with atypical fractures and unexplained anemia, emphasizing urgent HVS management and integrated therapies. The educational message underscores the need for a multidisciplinary approach to improve outcomes, even in resource-limited settings.
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