An Unusual Myeloma Case with Normal Erythrocyte Sedimentation Rate and Serum Immunoglobulins

Multiple Myeloma (MM) is a disease characterized by the increase of plasma cells in bone marrow or in other tissues and increased production of abnormal immunoglobulin (Ig) or Ig parts. In this report, we aimed to present a case of myeloma whom showed in our clinic with complaints of diarrhea, vomiting, fatigue and difficulty in walking. A 68- year-old male patient presented with diarrhea, fatigue, nausea, vomiting, and loss of appetite. He had splenomegaly in physical examination. Laboratory test revealed erythrocyte sedimentation rate: 4 mm/h and corrected calcium: 11.1 mg/dl. In conclusion, despite it is rare, multiple myeloma case may present with normal erythrocyte sedimentation rate and serum immunoglobulin levels. Anemia, bone lesions and hypercalcemia in an elderly may prompt diagnostic effort for multiple myeloma.

Osteomyelitis

•Clinical: Localized pain and tenderness of involved bone; systemic signs and symptoms of acute hematogenous osteomyelitis•Radiology: Bone destruction or sequestrum in chronic cases; use of nuclear scanning, magnetic resonance imaging, or computed tomography may aid diagnosis and staging•Laboratory: White blood cell count is often normal; erythrocyte sedimentation rate and C-reactive protein are usually elevated...

Leflunomide and Azathioprine Combination in Refractory Adult-Onset Still's Disease

OBJECTIVE: To present a case of Adult-onset Still's disease (ASD) in a patient who was successfully treated with leflunomide and azathioprine. CASE SUMMARY: A 24-year-old woman with ASD was initially treated with indomethacin, corticosteroids, and hydroxychloroquine; there was no clinical improvement. Methotrexate was added to the regimen, followed by azathioprine. The patient still experienced disease flares with this treatment, and cyclophosphamide was started. However, because of persisting disease activity, leflunomide combined with azathioprine was given. Only on this regimen was complete disease control achieved, with a normal erythrocyte sedimentation rate as well as normal C-reactive protein and ferritin levels. No recurrences or adverse effects attributable to leflunomide or azathioprine were observed at the one-year follow-up. DISCUSSION: Clinical experience concerning leflunomide and azathioprine combination in ASD is limited. This combination may be modifying the clinical expression of ASD through its effects on T lymphocyte clonal expansion and production of proinflammatory cytokines. CONCLUSIONS: Leflunomide combined with azathioprine appears to be an effective and safe treatment of ASD.