Letter to the Editor / Editöre Mektup doi: 10.5606/fng.btd.2019.031 FNG & Demiroğlu Bilim Tıp Dergisi 2019;5(3):176-178 Multiple myeloma associated with osteosclerotic and osteolytic lesions Damla Çağla Patır 1 , Ahmet Peker 1 , Cengiz Ceylan 2 , Harun Akar 1  1 Department of Internal Medicine, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey 2 Department of Hematology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey Osteosklerotik ve osteolitik lezyonlarla ilişkili multipl myelom Multiple myeloma (MM) is a hematologic malignancy associated with an uncontrolled and monoclonal increase in plasma cells, the mature form of B lymphocytes. In most patients, monoclonal paraproteins are detected in serum and urine. [1] The disease is characterized by lytic bone lesions, presence of M protein in serum and urine, and plasma cell infiltration in the bone marrow. Lymphadenopathy is rarely encountered. Multiple myeloma usually presents with fatigue, renal failure, bone pain, and weight loss. [2] Osteoblastic lesions are rare in multiple myeloma cases. In patients with multiple myeloma with osteoblastic lesions, this condition usually occurs with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes). [3] In this article, we hope to share a rare case of multiple myeloma associated with simultaneous osteolytic and osteosclerotic lesions. An 82-year-old male patient admitted to our outpatient clinic with complaints of weight loss, generalized chest pain and tenderness, and generalized body pain. Examinations revealed anemia and elevated erythrocyte sedimentation rate and the patient was admitted to the internal medicine ward for further examination and treatment. Physical examination showed fever of 37.6°C, blood pressure 130/62 mmHg, pulse 72 bpm and respiratory rate was 18 bpm. The patient had no organomegaly. Peripheral lymphadenopathy was not detected. Respiratory sounds were normal. Cardiac examination showed heart sounds were rhythmic and there was no additional sound or murmur. The patient had diffuse pain and tenderness in his chest region. The laboratory findings of the patient were as follows: Glucose: 119 mg/dL, Creatinine: 1.1 mg/dL, AST: 47 U/L, ALT: 25 U/L, Sodium: 135 mmol/L, Potassium 4.78 mmol/L, Calcium: 8.9 mg/dL, Albumin: 2.3 g/dL, Globulin: 4.8 g/dL, IgA: 3480 mg/dL, IgG: 413 mg/dL, IgM: 19.3 mg/dL, IgE: 24.4 mg/dL, Prostate specific antigen (PSA): 0.6 µg/L, WBC: 5,900¥10 9 /L, Hemoglobin: 12.4 g/dL, Platelet: 179¥10 9 /L, erythrocyte sedimentation rate: 120 mm/h. Thoracic computed tomography of the patient revealed fracture of the ribs. Head x-ray revealed lytic lesions. Whole-body bone scintigraphy showed heterogeneous osteoblastic activity in sternum and heterogeneous osteoblastic activity in T9-L1 vertebrae (Figure 3). When the peripheral blood smear was evaluated, rouleaux formation was present; the leukocyte formula was consistent with the hemogram, and the lymphocyte morphology was normal. Erythrocytes were normocytic and Received: June 26, 2019 Accepted: July 09, 2019 Published online: October 31, 2019 Correspondence: Damla Çağla Patır. Sağlık Bilimleri Üniversitesi, İzmir Tepecik SUAM, İç Hastalıkları Kliniği, 35180 Yenişehir, Konak, İzmir, Türkiye. Tel: +90 539 - 273 05 92 e-mail: damlapatir@yahoo.com Cite this article as: Çağla Patır D, Peker A, Ceylan C, Akar H. Multiple myeloma associated with osteosclerotic and osteolytic lesions. FNG & Demiroğlu Bilim Tıp Dergisi 2019;5(3):176-178.