The discovery of multiple myeloma during the evolution of lupus nephropathy: A case report and literature review

Abstract

Introduction: Systemic lupus erythematosus (SLE) has been proven to be independently associated with higher proportions of malignancies, particularly hematological patterns. We report a patient who developed multiple myeloma on underlying lupus nephropathy with poor outcome. Observation: It was a 48-year-old male patient followed in pneumology for bronchial dilatation secondary to pulmonary tuberculosis who consulted nephrology for an impure nephrotic syndrome without extra-renal signs and a renal biopsy outlining advanced endo and extra-capillary glomerulonephritis with 38% activity. The etiological investigation had revealed lupus. Despite 2 therapeutic protocols based on MMF + corticoids then cyclophosphamide + corticoids, there was no remission. He underwent conservative treatment for chronic kidney disease with stable renal function including a GFR of 27 ml/min/1.73m2. Two years after the discovery of lupus disease, the patient presented with a bleeding syndrome with a blood count showing normocytic normochromic anaemia at 4.1 g/dl, leukopenia at 830/mm3 and thrombocytopenia at 49000/mm3. The bone marrow count performed on the basis of this pancytopenia showed a plasmocytosis in 38% with a dysmorphic erythroblastic lineage (basophilic punctation and laminated cytoplasm), an absent megakaryocytic lineage and the presence of numerous naked plasma cells and dysmorphic plasma cells, numerous hemophagocytic macrophages and siderophages. Plasma protein electrophoresis did not show a monoclonal peak. The outcome was poor. Death occurred 3 days after his hospitalization in a medullary insufficiency course. Conclusion: Lupus can be the starting point for the development of a hematological malignancy at a later stage. On the other hand, cancer can induce spontaneous autoimmune manifestations or secondary to anti-tumor therapies. In our case it was a patient who developed myeloma 2 years after the onset of lupus with a poor outcome leading to death.