Painful swelling of the skull as the first symptom of multiple myeloma - a case report.

This article presents the case of a 53-year-old patient who reported to the neurology emergency room because of painful swelling of the left side of the forehead, temple and parietal region that had been persisting for 4 days. In the interview, the patient is under constant cardiology care due to pharmacologically treated hypertension, additionally diagnosed with nephrolithiasis and left intercostal neuralgia as a result of chronic cough that had been persisting for 2 months. Neurological physical examination revealed slight facial asymmetry, with the left eyeball set deeper and the zygomatic bone less prominent on the left side. Noteworthy was the swelling of the soft tissues of the left side of the head, covering half of the forehead, temple and parietal region, without involvement of the back of the head or the right side. The patient underwent an imaging examination of the head using computed tomography (CT). Due to ambiguous changes in the bones of the skull cap, an extension of the diagnostics was ordered with magnetic resonance imaging (MRI). Very numerous osteolytic foci were found, which enhanced after contrast administration, scattered throughout the skull bone, and at least one foci in the spine - in the apex of the dentary tooth. The most probable origin of the changes was indicated as multiple myeloma, for differential diagnosis with other metastatic changes. The patient underwent a hematological consultation, during which a bone marrow aspirate and protein tests were taken. The histopathological result revealed numerous plasma cells and a monoclonal protein peak (M). A date was set for the patient to be admitted to the Hematology Department for further treatment.