© Borgis - Medycyna Rodzinna 1, p. 24-28
*Magdalena Krzyżak-Jankowicz1, Joanna Świątoniowska2, Edyta Kuźmińska2
Przewlekły ból odcinka lędźwiowo-krzyżowego kręgosłupa jako główny objaw szpiczaka mnogiego u 62-letniej chorej – opis przypadku
Chronic low back pain as the predominant symptom of multiple myeloma in 62-years old woman – case report
1Ośrodek Kształcenia Lekarzy Rodzinnych we Wrocławiu
Kierownik Ośrodka: lek. med. Jan Wolańczyk 2NZOZ Dla Zdrowia Praktyka Lekarza Rodzinnego; Wrocław
Kierownik NZOZ-u: lek. med. Joanna Świątoniowska
Summary
Multiple myeloma is a hematological cancer, characterized by the neoplastic proliferation of a single clone of plasma cell producing a monoclonal protein. The incidence of multiple myeloma increases with age. The median age ad diagnosis is between 63 and 70 years old. Myeloma may be quite difficult in diagnosis. It may simulate a huge number of diseases. The major clinical manifestations of multiple myeloma are related to loss of bone. This bone loss often leads to pathologic fractures, spinal cord compression, hypercalcemia and bone pain. This enhanced bone loss occurs because of the stimulation of the cells responsible for bone resorption – the osteoclasts. These osteoclastic activating factors, including lymphotoxin (tumor necrosis factor) (TNF ß) and interleukin 1ß (IL-1ß). Interleukin 11 (IL-11) stimulates osteoclastogenesis and inhibits bone formation. Other symptoms of multiple myeloma are anaemia, leucopenia, thrombocytopenia, hyperproteinemia with decreased serum albumin, elevated serum C-reactive protein (CRP) and kidney dysfunction. Patients suffer from multiple myeloma often require analgesics, such as paracetamol and weak or strong opioids, but nonsteroidal anti-inflammatory drugs (NSAIDS) are contraindicated.
The authors presents a case of the 62-years old woman with myeloma multiple, who had chronic low back pain as the predominant symptom, noncharacteristic laboratory findings: macrocytic anaemia, without hypercalcemia and elevated serum CRP. Kidney function was normal.
Key words: multiple myeloma, chronic low back pain, bone loss, hyperproteinemia, NSAIDS
Piśmiennictwo
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otrzymano/received: 2007-12-10
zaakceptowano/accepted: 2007-12-14
Adres/address:
*Magdalena Krzyżak-Jankowicz
Ośrodek Kształcenia Lekarzy Rodzinnych we Wrocławiu,
pl. Dominikański 6, 50-159 Wrocław
tel. 605 578 301, (0-71) 3447332
e-mail: magda.lek@wp.pl, mkrzyzak-jankowicz@plr.pl
