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IMAGE IN HEMATOLOGY
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 106-107

A case of iga-kappa multiple myeloma with intracytoplasmic Auer rod-like inclusions


1 Laboratory of Hematology, Military Hospital, Tunis, Tunisia
2 Laboratory of Hematology; Molecular Biology Unit (UR17DN06), Laboratory of Hematology, Military Hospital, Tunis, Tunisia
3 Molecular Biology Unit (UR17DN06), Laboratory of Hematology, Military Hospital, Tunis, Tunisia
4 Department of Hematology, Military Hospital, Tunis, Tunisia

Date of Web Publication14-Nov-2019

Correspondence Address:
Dr. Najiba Fekih-Mrissa
Molecular Biology Unit (UR17DN06), Laboratory of Hematology, Military Hospital, 1008 Mont Fleury, Tunis
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_43_19

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How to cite this article:
Bouzidi S, Nasr AA, Bouzguenda S, Layouni S, Fekih-Mrissa N, Msadek F, Nsiri B. A case of iga-kappa multiple myeloma with intracytoplasmic Auer rod-like inclusions. J Appl Hematol 2019;10:106-7

How to cite this URL:
Bouzidi S, Nasr AA, Bouzguenda S, Layouni S, Fekih-Mrissa N, Msadek F, Nsiri B. A case of iga-kappa multiple myeloma with intracytoplasmic Auer rod-like inclusions. J Appl Hematol [serial online] 2019 [cited 2019 Dec 13];10:106-7. Available from: http://www.jahjournal.org/text.asp?2019/10/3/106/271027

A 78-year-old woman was admitted to the Hematology Department in the Military Hospital of Tunis in March 2018 with impaired general performance status, suffering from severe bone pain, lumbar region pain, and polyarthralgia. On physical examination, she presented with pallor and asthenia but without any organomegaly. Her medical history was insignificant aside from hypertension. A bone scan on the hands, ankles, and pelvic bones revealed no signs of osteoarthritis and normal bone mineralization. Routine laboratory investigations yielded the following results: plasma creatinine 89 μmol/L (normal range 60–120), calcemia 2.38 mmol/L (normal range 2.25–2.75), urea 6.5 mmol/L (normal range 2.5–7.5), uric acid 528 μmol/L (normal range 150–360), C-reactive protein 6 mg/L (normal range <6), and normal serum levels of aspartate amino transferase, alanine amino transferase, and thyroid balance. Immunological assessment was negative for both anti-cyclic citrullinated peptide antibodies and anti-nuclear antibodies. A complete blood count showed a hemoglobin level of 11.6 g/dL, white blood cells 8 × 109/L, and platelets 307 × 109/L. Serum protein electrophoresis revealed hypogammaglobulinemia with a peak in the β-globulin fraction. Immunofixation electrophoresis detected monoclonal IgA-kappa (κ) paraprotein in both serum and urine. Quantitative evaluation of the light chains of immunoglobulin identified κ chains 750 mg/L and lambda (λ) chains 10 mg/L, with a ratio κ/λ = 75 (normal range 0.26–1.65). May–Grünwald–Giemsa-stained bone marrow aspirate smears showed a bone marrow infiltration of 27% malignant plasma cells with atypically formed (i.e., fiaming cytoplasm, Russell bodies, and partly bi- or multi-nucleated cells with multiple nucleoli). Approximately, 30% of these abnormal plasma cells contained numerous intracytoplasmic, spindle-shaped, and azurophilic crystalline Auer rod-like depositions [Figure 1]; however, the results of myeloperoxidase staining were negative.
Figure 1: Bone marrow showing a plasma cell with Auer rod-like inclusions (May–Grünwald–Giemsa stain, ×1000)

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Based on these findings, a diagnosis of IgA-κ multiple myeloma with Auer rod-like inclusions was established.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Confiicts of interest

There are no confiicts of interest.


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