Vnitr Lek 2020, 66(5):316-321 | DOI: 10.36290/vnl.2020.088

Osteolytic bone lesions, hypercalcemia and paraprotein, but not a myeloma: case report and review of literature

Katarína Hradská¹, Tomáš Jelínek¹, Juraj Ďuraš¹, Jana Mihályová¹, Tereza Popková¹, Jakub Cvek², Kamil Bukovanský³, Martin Havel³, Veronika Spáčilová⁴, Roman Hájek¹

¹ Klinika hematoonkologie LF OU a FN Ostrava

² Klinika onkologická LF OU a FN Ostrava

³ Klinika nukleární medicíny LF OU a FN Ostrava

⁴ Interní klinika LF OU a FN Ostrava

In June 2018, 77-year-old man was referred to The Department of Haematooncology, University Hospital Ostrava, for suspicion of multiple myeloma. This was supported by laboratory findings of hypercalcemia, paraprotein IgA κ in serum and by the presence of multiple osteolytic skeletal lesions. Low number of plasma cells in bone marrow sample - cytologically (3.6 %) as well as in flow cytometry (less than 95 % clonal plasma cells out of total bone marrow plasma cells) - pointed at the direction of monoclonal gammopathy of undetermined significance (MGUS). In the course of differential diagnosis of hypercalcemia, elevated level of parathormone had been found which led to the performance of 99mTc-MIBI scintigraphy where parathyroid adenoma was discovered and later histologically verified. The final diagnosis was determined as a coincidence of MGUS and primary hyperparathyroidism. This case report also contains brief differential diagnosis of hypercalcemia and osteolytic skeletal lesions and suggestions for their diagnostic algorithms.

Keywords: hypercalcemia, MGUS, multiple myeloma, osteolytic lesions, primary hyperparathyroidism.

Published: August 1, 2020  Show citation