2011 issue 1

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Volume 20, issue 1

Case report

A rare case of bacterial encephalomeningitis as a preliminary symptom of multiple myeloma

Małgorzata Wiszniewska1, Marcin Rogoziewicz1, Anna Szmydt1, Paweł Wiszniewski2
1. Oddział Neurologii Szpitala Specjalistycznego im. Stanisława Staszica, Piła
2. Oddział Chorób Wewnętrznych i Hematologii Szpitala Specjalistycznego im. Stanisława Staszica, Piła
Postępy Psychiatrii i Neurologii 2011, 20(1): 75–79
Keywords: multiple meyloma, bacterial meningitis, treatment

Abstract

Background. The aim of this article is to present a rare case of bacterial meningitis which turned out to be the first symptom of multiple myeloma. Multiple myeloma is a neoplasm characterised by clonal proliferation of atypic plasmocytes. Anemia, osteolytic lesions, hypercalcemia, renal failure, and osteal pain are the most common symptoms of the disease. Spinal cord lesions, radiculopathy, as well as cranial and peripheral nerve palsy predominate among neurological disorders associated with multiple myeloma. The illness leads to humoral immunity impairment and increases the patients' vulnerability to bacterial infections, including bacterial meningitis. Meningeal and cerebral involvement is very rare as an initial manifestation of myeloma.
Case report. A 69-year-old male was diagnosed with severe acute bacterial meningitis that proved to be the first clinical manifestation of multiple myeloma. Combined antibiotic therapy with a supplementary treatment ameliorated the signs of meningitis. Combined treatment of multiple myeloma with thalidomide and dexamethasone was successful. The patient remains under the care of a hematologist and neurologist.
Commentary. We present this case to emphasize that bacterial meningitis occasionally may be a first manifestation of multiple myeloma. It is very important to make an accurate and rapid diagnosis that allows to initiate complex treatment of both meningitis with antibiotics and subsequently of myealoma with immunosuppressive agents. Such management increases the patient's chance not only of survival, but also of a better quality of life after treatment completion. We would like to emphasize that a good collaboration between neurologists and hematologists is necessary in such cases.

Address for correspondence:
Małgorzata Wiszniewska
Oddział Neurologii Szpital Specjalistyczny im Stanisława Staszica
ul. Rydygiera 1, 64‒920 Piła
e-mail: mpwisz@pi.onet.pl