以头晕为主要表现的多发性骨髓瘤确诊启示

Diagnosis of Multiple Myeloma with Dizziness as the Main Manifestation

目的加强对多发性骨髓瘤(multiple myeloma,MM)临床特点的认识,探讨急诊头晕患者的正确诊断思维。方法对我院急诊科近期确诊的1例以头晕为主要表现的MM病例资料进行回顾性分析。结果患者为60岁男性,以间断活动后出现气促,头晕、乏力1年,加重伴恶心1 d入院。1周前因左肩部疼痛就诊骨科,胸椎MRI检查示第7颈椎~第2胸椎左侧椎间孔内外占位性病变。1 d前患者头晕、恶心加重,来院急诊,血常规提示重度贫血,采集血生化检查标本时常规离心无法析出血清,考虑为M蛋白增多导致,行骨髓穿刺病理检查示:浆细胞系统异常增生,骨髓瘤细胞占68.5%。入院14 h确诊MM。结论接诊气促、头晕、乏力、贫血以及特定部位慢性骨痛者,当出现血液标本血清析出困难时应高度可疑MM,行骨髓穿刺病理检查可快速明确诊断。

Objective To strengthen understanding for clinical features of multiple myeloma （MM） in order to investigate correct thinking for patients with dizziness. Methods Clinical data of 1 MM patient with dizziness as the main perform- ance was retrospectively analyzed. Results A 60 year-old male patient was admitted for shortness of breath, dizziness and fatigue after discontinuous activity for 1 year and aggravation associated by nausea for 1 day. The patient visited in orthopaedic department 1 week ago for left shoulder pain, and thoracic vertebrae magnetic resonance imaging MRI showed space occupying lesion from the 7th cervical vertebrae to the 2^nd thoracic vertebrae of inside and outside intervertebral foramen. The patient visi- ted in emergency department for dizziness and nausea aggravation 1 day ago. Blood routine examination showed severe anemia, but the serum couldn’t be centrifuged from blood samples for biochemical examination, and then increasing M protein was con- sidered. Bone marrow biopsy showed that plasma cells system was paraplasm, and percentage of myeloma cell was 68.5% , and then MM was confirmed 14 hours after admission. Conclusion Patients with shortness of breath, dizziness, fatigue, anemia and chronic bone pain in special parts should highly suspected as having MM when serum precipitation was difficulty in blood samples, and bone marrow puncture can quickly confirm diagnosis.