| 英文摘要 |
A 42-year-old medical technologist with thalassemia history visited our hospital in 2000 because of lower back pain and morning stiffness for six months. There was no trauma, skin lesion, fever, sport injury, or body weight loss. A diagnosis of ankylosing spondylitis (AS) was made by ankylosis of bilateral sacroiliac joints (Fig. A), morning stiffness, and decreased Schober test. Beside, HLA-B27 was positive. Other laboratory test revealed the following values: Cr 1.1 mg/dL; ESR 26 mm/h; and calcium 9.1 mg/dL (7.9-9.9); and lower IgA 56.8 mg/dL (75-375). X-ray of T-L spine (Fig. B) showed osteoporotic change with compression fracture over the eighth thoracic vertebrae. The activity of AS and back pain was then controlled with sulfasalazine and nonsteroid anti-inflammatory drugs. Until 2004, after 2-year loss follow-up, he came for aggravated persistent back pain. Body weight loss for 5 kg in half a year was noted. X-ray of T-L spine (Fig. C) showed worsening kyphosis, osteoporotic change and multiple compression fractures. Blood test results were: hemoglobin 8.2 g/dL, MCV 71.7 FL, Cr 0.9 mg/dL, AST 29 U/L, ESR 105 mm/h, IgG 6060 mg/dL (680-1530), IgM 24.7 mg/dL (40-170), IgA 14.4 mg/dL and β2-microglobulin 3869.8 μg/L (800-2400). Serum protein electrophoresis revealed monoclonal spike at gamma-globulin fraction. Bone marrow examination demonstrated 46.2% of plasma cells (Fig. D). IgG-kappa multiple myeloma, stage IIIA, was made. This patient was died few months later due to treatment failure of multiple myeloma. |
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