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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| An Unusual Presentation of Multiple Myeloma with Spontaneous Subarachnoid Hemorrhage from Skull Base Involvement and Thrombocytopenia: Case Report and Literature Review Swapnil Surpur, Sameer Bhimani, Ifunanya Ekechukwu, Tushar Abhinav, Aadhyaa Shenoy, James Cortese. The Wright Center for GME, Scranton, PA, USA |
Abstract
Background: Multiple myeloma (MM) is a plasma cell malignancy with heterogeneous clinical manifestations, commonly presenting with anemia, renal dysfunction, skeletal lesions, and hyperproteinemia. Hemorrhagic complications are uncommon, and spontaneous subarachnoid hemorrhage (SAH) due to skull base involvement in undiagnosed MM is exceedingly rare. Case Presentation: We report a 68-year-old male presenting with acute weakness and altered mental status. Laboratory evaluation revealed severe anemia (Hb 6.6 g/dL), thrombocytopenia (85 × 10⁹/L), renal impairment (creatinine 2.4 mg/dL), hyponatremia, hyperuricemia, and hyperproteinemia (total protein 13.0 g/dL). Peripheral smear showed normocytic normochromic anemia with marked rouleaux formation. Neuroimaging demonstrated a right superior frontal SAH and diffuse skull base lytic lesions; MRI excluded leptomeningeal disease. Serum protein electrophoresis revealed an IgG lambda monoclonal spike (7.26 g/dL). Flow cytometry and bone marrow biopsy confirmed MM with secondary plasma cell leukemia. Initial therapy with dexamethasone and allopurinol was followed by outpatient initiation of daratumumab-VRd. Follow-up PET-CT after four cycles showed resolution of prior osteolytic lesions with ongoing hematologic response. Discussion: This case highlights a rare thrombo-hemorrhagic presentation of MM with secondary plasma cell leukemia. Spontaneous SAH in the context of diffuse skull base involvement emphasizes the hematologic risk factors for bleeding, including thrombocytopenia and paraproteinemia, and underscores the importance of early recognition and management of coagulation abnormalities in MM. The patient demonstrated a favorable interim response to daratumumab-based therapy, illustrating the effectiveness of targeted regimens in complex clinical scenarios. Conclusion: Clinicians should maintain a high index of suspicion for plasma cell neoplasms in patients presenting with pancytopenia, renal dysfunction, and spontaneous intracranial hemorrhage. Early diagnosis and prompt initiation of anti-myeloma therapy, even in the setting of hemorrhagic complications, can lead to favorable outcomes. This case provides insight into the intersection of hemostasis and plasma cell malignancy and is relevant for thrombosis and hemostasis-focused discussions.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.