Multiple myeloma associated to secundary Sjögren síndrome : first Colombian case report. Mieloma múltiple asociado a síndrome de Sjögren secundario : primer reporte de caso colombiano.

Abstract

The association between multiple myeloma (MM) and Sjögren syndrome (SS) is rarely seen. In the following article we present a case report of a Colombian 68 year old female patient with multiple myeloma IgG lambda and SS that responded well to chemotherapy. Initially the patient arrived in the emergency room with acute chest pain and dry eyes and mouth. During her physical exam the only symptom she experienced was pain in her 5th rib. She had complete blood count with hemoglobin of 8.3 g/dl and 25% hematocrit, an erythrocyte sedimentation rate of 120 mm/h and a creatinine of 2.8 mg/dl. Serum protein electrophoresis demonstrated a monoclonal band in the gamma region, with an immunoelectrophoresis with a monoclonal band IgG lambda. Total immunoglobulin quantification showed an elevated IgG and diminished IgM. In addition she had a beta-2 microglobulin level of 440 nmol/l. Skeletal survey was negative for any lytic bone lesions. Bone Marrow biopsy was positive for 95% bone marrow infiltrate by plasma cells in different stages of maturation. Cytogenetics not available. She was treated with 4 cycles of vincristine, doxorubicin, dexamethasone (VAD regimen). After 5 months follow up she was completely asymptomatic for both MM and SS. Simultaneous presentation of both diseases is extremely rare, and although there is literature with many hypotheses of a common origin for both diseases, there is no clear evidence to this effect. There is a need for further research about the genetic and environmental associations between these two diseases to understand their true etiology.