以过敏性紫癜为首发表现的多发性骨髓瘤1例

Multiple Myeloma with Henoch-Schonlein Purpura as the Initial Manifestation:A Case Report

患者男,54岁,躯干及四肢反复起紫癜瘀斑4个月,间断发热2个月余。皮肤科情况:四肢及躯干可见散在或群集的针尖至粟粒样可触及性紫癜,部分融合成片。血清免疫固定电泳见IgA-kappa型M蛋白。骨髓活检见40.3%的异常单克隆浆细胞,CD38(+)、CD138(+)、IgA轻链Kappa(+)。诊断:多发性骨髓瘤(IgA-κ轻链型,ISS分期Ⅱ期)。经PCD化疗方案硼替佐米联合环磷酰胺及地塞米松治疗后,随访6个月,患者一般情况良好,全身紫癜消退。

A 54-year-old male presented with recurrent purpura and ecchymosis on the trunk and limbs for 4 months,and intermittent fever for more than 2 months.Dermatological examination showed scattered or clustered pintip to millet size palpable purpura on the limbs and trunk,some fused into patches.Serum immunofixation electrophoresis detected an IgA kappa M-band.Bone marrow biopsy showed 40.3%abnormal monoclonal plasma cells expressing CD38(+),CD138(+)and IgA light chain kappa.A diagnosis of multiple myeloma(IgAκlight chain type,ISS stageⅡ)was made.After the treatment with PCD chemotherapy regimen of bortezomib,cyclophosphamide and dexamethasone and a 6-months follow-up,the general condition of the patient was good and the systemic purpura subsided.