Case Report: Underlying Immunodeficiency and Early-Stage Multiple Myeloma
Posted: Monday, February 1, 2021
For patients with multiple myeloma, infection with the microorganism Cryptococcus has rarely been documented, according to a study published in the Pan African Medical Journal. The susceptibility to infection may be associated with deterioration of the immune system due to multiple myeloma, leading to an immunocompromised state, where a patient may become more vulnerable to cryptococcal infection, reported Riadh Battikh, MD, of the Military Hospital, Tunis, Tunisia, and colleagues.
A 63-year-old male presented with complaints of persistent, worsening headaches and fever over 2 months. He also reported visual dysfunction and emesis. Physical examination did not reveal any abnormalities aside from bilateral stage I papilledema. The physicians ordered a basic metabolic panel, which revealed lymphopenia, anemia, hyperfibrinogenemia, and elevated C-reactive protein levels. Furthermore, results from an audiogram showed bilateral perceptive deafness. These findings prompted an examination of the cerebrospinal fluid and serum, which identified infection with Cryptococcus neoformans; this led to a diagnosis of cryptococcal meningoencephalitis.
Since C neoformans normally present in immunocompromised patients, the investigators began searching for an underlying immunodeficiency. Further analysis revealed hypoalbuminemia, hypogammaglobulinemia, and the presence of monoclonal IgA-lambda paraproteinemia. Moreover, Bence-Jones proteins were identified via urinalysis, and malignant plasma cells with atypical bi- or multinucleated cells were isolated in a May-Grunwald-Giemsa bone marrow aspirate. These abnormalities were consistent with a diagnosis of multiple myeloma.
The patient was treated for his C neoformans infection with an amphotericin B and flucytosine regimen. Following a negative fungi culture and cryptococcal antigen test, the patient was switched to treatment with fluconazole. Consequently, the patient was treated for his multiple myeloma, which resolved without additional complications.
Disclosure: For full disclosures of the study authors, visit panafrican-med-journal.com.