J Korean Rheum Assoc.  2009 Jun;16(2):156-160. 10.4078/jkra.2009.16.2.156.

IgA Multiple Myeloma Presenting with Pathologic Fracture at Clavicle in a Patient with Ankylosing Spondylitis

• Kwon HY
• Han SW
• Kwon JK
• Choi JW
• Lee KS
• Kwon KT
• Kim GW

• KMID: 2202132
• DOI: http://doi.org/10.4078/jkra.2009.16.2.156

Abstract

Multiple myeloma (MM) is a malignant monoclonal proliferation of plasma cells that commonly causes pathologic fractures in the vertebrae, femur, humerus and rib. Although the association of MM and ankylosing spondylitis (AS) has rarely been reported, most of MM patients with AS share the characteristic of IgA type paraproteinemia, which suggests the presence of mechanisms that possibly connect the two conditions. In this report, we describe a 47-year-old man with a 25-year history of AS, and he was diagnosed as having IgA kappa type MM with a pathologic fracture at the left clavicle. To the best of our knowledge, this is the first case of IgA myeloma presenting with a pathologic fracture in a patient with AS. We report here on this case along conducting a review of the relevant medical literature.

Keyword

Multiple myeloma; Ankylosing spondylitis

MeSH Terms

Clavicle
Femur
Fractures, Spontaneous
Humans
Humerus
Immunoglobulin A
Middle Aged
Multiple Myeloma
Paraproteinemias
Plasma Cells
Ribs
Spine
Spondylitis, Ankylosing
Immunoglobulin A

Figure

• 

  Fig. 1. (A) Axial computed tomography image with soft tissue and bone window shows multiple disruptions of cortical continuity of left clavicle (arrows) and (B) reconstructed 3D image demonstrates a non-displaced irregular fracture line at the middle clavicular shaft (arrow).

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  Fig. 2. (A) Lateral radiograph of skull demonstrates characteristic multiple punched-out lesions with variable sizes. (B) The anterior view of radionuclide bone scan shows accumulation of activity in left middle (arrow head) clavicle and posterior view shows multiple accumulations at both lower ribs (arrows).

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