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CASE REPORT
Year : 2022  |  Volume : 18  |  Issue : 1  |  Page : 37-40

Massive splenomegaly as the presenting feature of multiple myeloma in an elderly man


1 Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Correspondence Address:
Dr. Sankha Shubhra Chakrabarti
Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_15_22

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A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib–lenalidomide–dexamethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom's macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.


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