DR. SUBASH MOHAN THULASI,DR. ASHA GOPAN G P,DR. SORNAVALLI VALLIAPPAN,DR. THILAGAVATHI VENKATESAN
DOI: https://doi.org/Background: Multiple myeloma is a plasma cell malignancy that typically presents with anemia, bone pain, hypercalcemia, renal dysfunction, and lytic skeletal lesions. Extramedullary plasmacytomas represent an uncommon manifestation, often occurring in the upper aerodigestive tract. Involvement of the scalp and skull vault as an initial presentation is extremely rare.
Case Presentation: We report the case of a 60-year-old male who presented with a progressive right scalp swelling of two months’ duration, associated with pain for one week. Laboratory evaluation revealed hypercalcemia, normal renal function, and absence of urinary Bence Jones protein. Imaging demonstrated multiple lytic lesions in the skull and axial skeleton. Serum electrophoresis confirmed IgA kappa monoclonal gammopathy. Bone marrow examination revealed plasmacytosis with atypical plasma cells strongly positive for CD138. PET-CT confirmed multifocal lytic lesions. The patient was diagnosed with multiple myeloma with extramedullary involvement and initiated on a bortezomib, lenalidomide, dexamethasone (VRd) regimen along with intravenous zoledronic acid.
Conclusion: This case highlights an unusual initial presentation of multiple myeloma with scalp swelling due to extramedullary plasmacytoma. Recognition of such atypical manifestations is vital to prevent diagnostic delay. Review of literature emphasizes that extramedullary disease portends a poorer prognosis and requires prompt systemic therapy.
