Osteosclerotic myeloma associated with spinal tuberculosis with neurological manifestation: A case report

Background: Coincidental presentation of osteosclerotic myeloma and spinal tuberculosis is an unusual and rare disease condition. Dissimilar data about diagnosis and treatment from various hospitals and different countries are reported. Spinal tuberculosis is the most dangerous form of tuberculous infection which commonly leads to a gradual onset of neurological defi cit that are difficult to diagnose at the early stage; and its association with osteosclerotic myeloma with multiorgan involvementincluding polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes, the so-called “POEMS” syndrome are rare.
Case Report: A 57-year-old male civil servant was admitted into the medical ward of the University of Benin Teaching Hospital (UBTH) Benin City, Nigeria on July 10th 2007 on account of one year history of cough, low backache and progressive weight loss. Examination showed grade 2 finger clubbing with leuconychia, sensory loss at T12, L1, and L4 with gibbus formation at T12, L1 which was nontender, bone marrow plasmacytosis (10%), serum protein electrophoresis showed a reduction of circulating IgG monoclonal protein; radiographs of the thoraco-lumbar spine revealed generalized osteosclerosis of the vertebrae and an anterior wedge fracture of T12, L1 and L4.
Conclusions: Coincidental presentation of osteosclerotic myeloma and spinal tuberculosis with neurological involvement is rare, but has been reported in this case occurring in an African. Effective management of these patients is multidisciplinary.

Keywords: osteosclerotic myeloma , spinal tuberculosis, neurological, peripheral neuropathy