"多发性骨髓瘤相关兰伯-伊顿肌萎缩综合征:病例报告"

Sebastian S Casillas-Berumen , Ahsan Salik , Alex Yu , Mageda Al Areqi , Ayesha Ali , Resham Mirza , Shaan Chaudhri , Gurpreet Lamba
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引用次数: 0

摘要

背景兰伯特-伊顿肌萎缩综合征(LEMS)是一种不常见的神经肌肉接头疾病。它通常表现为近端肌肉无力、自主神经功能障碍和腱反射障碍。它通常与小细胞肺癌有关。我们报告了一例 54 岁女性的病例,她有吸烟史,出现全身无力。患者接受了多项检查,包括血液检查、肌电图和影像学检查。实验室检查结果显示患者存在高蛋白水平和贫血,这促使临床医生继续进行 SPEP 检查,结果显示 M 峰值升高,从而确诊为 MGUS。在症状恶化的情况下,患者接受了神经内科评估。电压门控钙通道抗体检测呈阳性,确诊为兰伯特-伊顿肌萎缩综合征。她接受了泼尼松、吡啶斯的明和氨苯蝶啶治疗,症状有所改善。几个月后,实验室检查显示 M 峰值不变,骨髓活检显示 10% 的 IgA 浆细胞,确诊为多发性骨髓瘤。结论LEMS与多发性骨髓瘤并存是一个临床实体,已发表的病例很少,由于对两者之间潜在联系的了解有限,给诊断和治疗带来了挑战。
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Lamber-Eaton myasthenic syndrome associated with multiple myeloma: A case report

Background

Lambert-Eaton myasthenic syndrome (LEMS) is an uncommon illness of the neuromuscular junction. It typically manifests as a combination of proximal muscular weakness, autonomic dysfunction, and areflexia. It is typically associated with small cell lung cancer. However, this paraneoplastic syndrome has been discovered in other clinical entities, such as multiple myeloma, which is a rare and infrequent occurrence.

Case presentation

We report the case of 54-year-old female with history of tobacco usage, who presented with generalized weakness. The patient underwent multiple tests, including blood work up, electromyography, and imaging. The laboratory results yielded high protein levels and anemia, which prompted clinicians to pursue SPEP work up that yielded an elevated M spike, establishing MGUS diagnosis. Neurology evaluation was done in the setting of worsening symptoms. Antibody testing was positive for voltage-gated calcium channels, establishing diagnosis for Lambert-Eaton Myasthenic Syndrome. She underwent prednisone, pyridostigmine and amifampridine treatment noticing symptom improvement. Months later lab work showed unchanged M spike, and bone marrow biopsy showed 10 % IgA plasma cells, establishing Multiple Myeloma. She was started on daratumumab, decadron, lenalidomide and later on stem cell transplantation with success.

Conclusions

Coexistence of LEMS with multiple myeloma is a clinical entity with few published occurrences, providing diagnostic and therapy challenges due to the limited knowledge known about the potential link between the two.

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