A case of multiple myeloma diagnosed by skin lesions/Deri bulgulari ile tani konulan bir multipl myelom olgusu

Multiple myeloma, being a malignant proliferation of plasma cells in the bone marrow, has clinical spectrum varying from monoclonal gammopathy with unknown significance to plasma cell leukemia. The presenting symptoms have usually been bone pain, pathologic fractures or repeating infections. In patients with multiple myeloma, amyloid depositions may be seen in the skin. This form, defined as primary systemic amyloidosis, is characterized by light-chain amyloid fibril depositions. Our case applied with multiple, asymptomatic, yellowish papules localized on the face, trunk, oral and genital mucosa, gradually increasing during the last two years. He had no complaints, except for slight weight loss. In routine tests, the patient had no pathological laboratory findings, except high C-reactive protein levels. Further research revealed histopathologic and immunohistochemical findings consistent with amyloidosis. Upon these results, immunoglobulin G levels were measured and found high, and in protein electrophoresis, IgG monoclonal gammopathy was determined. The diagnosis of multiple myeloma is made by bone marrow biopsy. This patient is presented for being an asymptomatic case diagnosed by skin findings of amyloidosis. (Turkderm 2010; 44: 170-3) Key Words: Multiple myeloma, amyloidosis, papular mucinosis Multipl myelom; kemik iliginde plazma hucrelerinin malin proliferasyonu olup, klinik spektrumu, sebebi bilinmeyen monoklonal gammapatiden plazma hucreli losemiye kadar degisebilmektedir. Hastalarin basvuru sikayeti genellikle kemik agrilari, patolojik kiriklar ya da tekrarlayan infeksiyonlardir. Multipl myelomda, hastalarda deride amiloid depolanmalari da gorulebilir. Primer sis-temik amiloidoz olarak tanimlanan bu form, hafif zincir amiloid fibrillerinin depolanmasiyla karakterizedir. Olgumuz, yuz, govde, agiz ici ve genital bolgede iki senedir giderek artan multipl asemptomatik sarimsi papullerle basvurdu. Hafif kilo kaybi disinda sis-temik bulgusu yoktu. Rutin tetkiklerinde C reaktif protein yuksekligi disinda patolojik laboratuar bulgusu olmayan hastanin yapilan ileri tetkiklerinde, histopatolojisi ve immunhistokimya bulgulari amiloidoz ile uyumlu geldi. Bunun uzerine istenen immunglobulin (Ig) G duzeyi yuksek, protein elektroforezinde Ig G monoklonal gamapati saptandi. Kemik iligi biyopsisi ile multipl myelom tanisi koyuldu. Hasta, amiloidozun deri bulgulari ile tani konulan, asemptomatik bir olgu olmasi nedeniyle sunulmaktadir. (Turkderm 2010; 44: 170-3) An