Multiple myeloma as the first manifestation of acquired immunodeficiency syndrome: a case report and review of the literature

Abstract

Various hematologic malignancies and solid tumors are increasingly diagnosed in patients with human immunodeficiency virus (HIV) infection and may be the presenting manifestation of acquired immunodeficiency syndrome (AIDS). Multiple myeloma, however, has never been reported as the presenting manifestation of AIDS. We report on a 34-year-old man who presented with back pain, paresthesias, paraparesis, vertebral bony disease, and an associated soft tissue mass. Biopsy of the mass revealed immature plasmacytes with very faint cytoplasmic expression of kappa light chains. Bone marrow biopsy revealed 25% infiltration with poorly characterized malignant cells and 15% polyclonal plasma cells. Immunofixation of serum and urine was positive for IgG kappa and kappa light chains, respectively. A bone survey revealed lesions in the skull, left femur bone, and the pelvis. The diagnosis of an anaplastic myeloma was made. Because of the poorly characterized nature of the malignant cells and the difficulties in immunophenotyping, serologic evaluation for HIV was undertaken and was positive. The concept of myeloma as an opportunistic neoplasm defining AIDS was considered. We discuss this view and recommend that patients with multiple myeloma with poorly characterized myeloma cells as well as difficulties in immunophenotyping should undergo testing for HIV infection.

Aggressive plasmablastic multiple myeloma in a 42-year-old: is inflammatory bowel disease or infliximab treatment to be blamed?

“…Based on this, the role of infliximab in precipitating multiple myeloma, if any, could be related to its immunosuppressive property. The finding of plasma cell myeloma in patients with HIV14 or in those on immunosuppressive therapy15 goes in the favour of immunosuppression as a prelude to myeloma.…”

Plasma cell disorders in HIV-infected patients: epidemiology and molecular mechanisms

“…These anaplastic myeloma cells are negative for the common leukocyte antigen, lysozyme, and the cytoplasmic immunoglobulins. Anaplastic MM can present as the first manifestation of AIDS [92,93]. 5) MM in HIV-infected patients tends to occur in anal sex patients.…”

“…In both our patients, MM was diagnosed more than 2 decades after HIV infection (Case 3 developed AIDS, and case 2 did not have AIDS). It is important to note that there have also been reports of MM as the first presentation of HIV/AIDS [92]. Therefore, it appears that MM occurs at various stages of HIV infection: some patients develop MM during the early stage of HIV infection, while the others will develop MM several decades later.…”

Evolving Spectrum of HIV-Associated Nephropathy

“…Non-AIDS defining cancers are becoming increasingly recognized in the HAART era, including myeloma, which occurs at a significantly higher rate among HIV-seropositive individuals and can be the first manifestation leading to the diagnosis of HIV infection [17,18]. HIV-seropositive patients who develop plasma cell disorders do so at a younger age, exhibit an antigen-driven process contributing to accelerated development of plasma cell disorders.…”