THE CERVICAL FRACTURE AS FIRST SYMPTOM OF MULTIPLE MYELOMA: A CASE REPORT

BRUNA LO SASSO¹, LUISA AGNELLO¹, ADA MARIA FLORENA², EMANUELA PAPPALARDO³, SALVATORE MILANO³, DANIELA BUTERA¹, CONCETTA SCAZZONE¹, GIULIA BIVONA¹, ANTONINO GIULIO GIANNONE², CHIARA BELLIA¹, MARCELLO CIACCIO^*1,³

¹Sezione di Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli Studi di Palermo, Palermo, Italy - ²Dipartimento di Scienze per la Promozione della Salute e Materno Infantile “G. D’Alessandro”, Università degli Studi di Palermo, Palermo, Italy- ³U.O.C. Medicina di Laboratorio - CoreLab - Dipartimento di Diagnostica di Laboratorio, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone” di Palermo, Via del Vespro Palermo, Italy

Introduction: Multiple Myeloma (MM) is a clonal disorder characterized by proliferation and accumulation of malignant pla- sma cells in the bone marrow. Bone disease occurs in approximately 80% of patients with newly diagnosed MM. The cervical spine is the least common site of disease involvement.

Case presentation: A 60-year-old female patient was referred to the Department of Neurosurgery for bone pain. A magnetic resonance imaging (MRI) scan showed a pathological fracture of the sixth cervical vertebra (C6). The laboratory tests and the bone marrow examination led to a diagnosis of IgA κ MM (Durie Salmon stage IIIA). The patient underwent a cervical arthrodesis and started systemic Bortezomib-Thalidomide-Dexamethasone (VTD) combination chemotherapy. During chemiotherapic treatment the patient underwent a vertebroplasty of L4-L5. After 4 VTD cycles, the patient was dismissed showing a very good partial remission (VGPR). Later the patient subjected herself to hematopoietic stem cell transplantation (HSCT) obtaining a complete remission.

Discussion: We report a clinical case of MM in which the fracture of cervical spine represents the clinical onset. Indeed this clinical presentation is not common in this type of monoclonal gammopathy. This case underlines the importance of suspecting MM in all cases of compromised bone.