Multiple myeloma with simultaneous cutaneous and central nervous system involvement

Abstract

Cutaneous involvement in multiple myeloma is an extremely rare occurrence that is underrecognized and akin CNS involvement, typically occurs late in the disease course, and is associated with an aggressive biology. Pathologic examination is key to the diagnosis and a standard of care treatment has not been established for these patients.

Keywords: leptomeningeal disease; multiple myeloma; skin malignancy.

Figure 1

On the day of admission, the patient was found to have new right upper extremity weakness and a papular rash (A) on the chest. Biopsy of a chest papule showed infiltration of the skin by plasma cells (B) with kappa light chain restriction (C). Evaluation of the weakness including MRI and CT scan of the head showed no significant findings. Cerebrospinal fluid examination demonstrated the presence of multiple plasma cells with Kappa light chain restriction (D)