Multiple myeloma with simultaneous cutaneous and CNS involve
Cutaneous involvement in multiple myeloma is an extremely rare occurrence that is underrecognized and akin CNS involvement, typically occurs late in the disease course, and is associated with an aggressive biology. Pathologic examination is key to the diagnosis and a standard of care treatment has not been established for these patients.

The present case has been published in the journal Clinical Case Reports. A 60‐y‐old gentleman presented with complaints of fever and right shoulder pain. A complete evaluation showed extensive lytic lesions involving the right clavicle, sternum, cervical and thoracic spine, as well as adjacent multiple soft tissue masses.

A biopsy of the right clavicular mass revealed an anaplastic plasmacytoma with kappa light chain restriction and a MIB1 index of 60%. Serum protein electrophoresis demonstrated a monoclonal IgG kappa, with an IgG level of 2.1 g/dL. The patient received radiation therapy (5000 cGy) to the right shoulder with improvement in symptoms and proceeded with induction therapy consisting of 4 cycles of lenalidomide and dexamethasone with an achievement of a very good Partial Response.

However, shortly after completion of this treatment, the patient complained of recurrent fevers and a bone marrow biopsy revealed sheets of plasma cells. Planned ASCT was postponed and further chemotherapy consisting of 3 cycles of CVAD (Cytoxan, vincristine, Adriamycin, and dexamethasone) was administered.

At the completion of this treatment, a bone marrow biopsy demonstrated <3% of PCs and the patient was scheduled for stem cell mobilization with Cyclophosphamide and G‐CSF. On the day of admission, he was found to have new right upper extremity weakness and a papular rash on the chest. Evaluation of the weakness including MRI and CT scan of the head showed no significant findings.

Cerebrospinal fluid examination demonstrated the presence of multiple plasma cells with Kappa light chain restriction. Biopsy of a chest papule showed infiltration of the skin by plasma cells with kappa light chain restriction as well. The patient declined further treatment and expired shortly after from disease progression.

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