SHM Converge Scientific Abstract ePoster Gallery-Newly Diagnosed Multiple Myeloma, Sacral Plasmacytoma in a 23-Year-Old Female

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This case report describes a rare presentation of multiple myeloma (MM) in a 23-year-old woman with a large sacral plasmacytoma causing severe low back pain, left leg weakness, constipation, urinary retention, and saddle anesthesia. She had a one-year history of intermittent back pain that acutely worsened, prompting evaluation at an outside hospital where MRI showed an expansile sacral mass. She was transferred to a tertiary center for further workup.<br /><br />Imaging revealed a 7.6 × 5.8 × 6.5 cm sacral mass with cortical destruction and extraosseous extension into surrounding soft tissues, compressing the spinal canal and neural foramina. Brain and full spine MRI showed no metastatic disease. Physical exam demonstrated neurologic deficits, and labs showed markedly elevated total protein, IgG, free kappa light chains, and a highly abnormal kappa/lambda ratio, all supporting a plasma cell disorder. CT-guided biopsy confirmed sacral plasmacytoma, and bone marrow biopsy established the diagnosis of multiple myeloma.<br /><br />Her hospital course focused on symptom control and urgent local treatment. Pain was managed with a hydromorphone PCA and multiple adjunct medications. Neurosurgery recommended conservative management with biopsy rather than surgery. She completed a 12-day inpatient radiation therapy course before discharge, with outpatient plan for systemic therapy using DARA-VRd followed by autologous stem cell transplantation.<br /><br />The authors emphasize that MM and plasmacytoma are extremely rare in young adults, but should remain on the differential diagnosis for severe bone pain and neurologic symptoms, especially when red flags such as urinary retention or saddle anesthesia are present. Delayed diagnosis can lead to serious complications including pathologic fractures, renal failure, and cauda equina syndrome.

Asset Subtitle

Jonathan Wong

Meta Tag

Author List Alexander Hammond, Antoni Wojtkowski, Farrah Malik, Jonathan Wong

Category Clinical Vignettes

Concept Neurologic Deficit

Concept Urinary Retention

Concept Multiple Myeloma

Concept Sacral Plasmacytoma

Concept Spinal Pathology

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Jonathan Wong

Track Adult

Keywords

multiple myeloma

sacral plasmacytoma

young adult

back pain

neurologic deficits

spinal canal compression

urinary retention

saddle anesthesia

bone marrow biopsy

radiation therapy

Neurologic Deficit

Urinary Retention

Multiple Myeloma

Sacral Plasmacytoma

Spinal Pathology