CLINICAL CASE IN THE PRACTICE OF RHEUMATOLOGIST: MULTIPLE MYELOMA UNDER THE MASK OF POLYARTERITIS NODOSA
Summary. Systemic vasculitis are characterized by a multiplicity of lesions of internal organs and a variety of clinical manifestations that can occur in patients with a non-rheumatological profile. In order to expand the skills of differential diagnosis of systemic vasculitis, a case of multiple myeloma (MM) in a patient with clinical symptoms similar to the manifestation of polyarteritis nodosa (PN) has been described. Materials and methods. Primary diagnosis «Polyarteritis nodosa» was diagnosed in 50-old woman, according to classification criterias of the American College of Rheumatologists: weight loss >4 kg, reticular livedo, polyneuropathy of the upper extremities, increase of creatinine >133 μmol/l. Discussion. But clinical picture was characterized by absence of typical clinical symptoms of PN — pain/weakness in the muscles of the lower extremities, infection with hepatitis B virus, erythrocyturia and presence of isolated proteinuria. Patient was examined for serum protein fractions, which revealed a boost of M-gradient to 10%. The following sternal puncture showed the clinical picture of MM. The serum calcium concentration was normal and tomographic examination of the skeletal bones did not reveal lytic lesions. The only symptom that suspected MM was isolated proteinuria. Conclusions. It is necessary to pay attention to absence of some typical diagnostic criterias in all patients with signs of systemic vasculitis, even with a set of symptoms sufficient for its establishment.
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