IP International Journal of Maxillofacial Imaging 2024;10(1):35–37 Content available at: https://www.ipinnovative.com/open-access-journals IP International Journal of Maxillofacial Imaging Journal homepage: https://www.ijmi.in/ Case Report Multiple punched out lesions: A case report of multiple myeloma Mrunmayee Shrikant Durugkar 1 *, Mahendra Patait 2 , Kedar Saraf 2 , Yogini Marathe 3 , Kartikee Vinit Bhoir 2 1 Private Practitioner, Pune, Maharashtra, India 2 Dept. of Oral Medicine & Maxillofacial Radiology, SMBT Dental College, Hospital & Research Institute, Sangamner, Maharashtra, India 3 Private Practitioner, Mumbai, Maharashtra, India ARTICLE INFO Article history: Received 08-03-2024 Accepted 29-03-2024 Available online 14-05-2024 Keywords: Multiple myeloma Punched out radiolucency Plasma cell proliferation ABSTRACT Multiple myeloma (MM) is a relatively uncommon malignant neoplasm, characterized by abnormal proliferation of plasma cell. It usually has a multicentric origin within the bone. It constitutes about 1% of all malignancies and 15% of all hematologic malignancies. We present a case of a 25-year-old male patient who presented with a gingival enlargement in the maxilla and mandible with punched-out radiolucencies in the skull and mandible. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons AttribFution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com 1. Introduction MM is a lymphoid malignancy, characterized by clonal proliferation of plasma cells. 1 MM is a rare malignant hematological disease having unknown etiology. 2 It is seen between 50 to 80 years of age and twice often in men. The common signs and symptoms are anemia, bone pain, fatigue, infections. Radiologically characterized by multiple punched-out radiolucent lesions. 3 Maxillofacial manifestations of MM are an initial sign and present a primary manifestation of the advanced stages of the disease. The maxillofacial lesions seen in the posterior mandible showing symptoms like odontalgia, paresthesia, mobile teeth, gingival hemorrhage and ulcers. 4 We present a case of multiple myeloma involving the mandible in a 25- year-old man with gingival enlargement in the maxilla and mandible with multiple punched out lesions. We consider this case to be different from others as the * Corresponding author. E-mail address: mrunmayeedurugkar@gmail.com (M. S. Durugkar). patient involved here is younger than common age involved and well-defined osteolytic lesions were seen. 2. Case Report Clinical findings: A 25 years old male patient reported to the department of Oral Medicine and Radiology with chief complaint of generalized mobile teeth in both jaws since past 3 to 4 months. Again on detail history taking patient gave history of weakness, backache, inability to sleep and vomiting on taking any food from last 1 to 2 months. On palpation in the neck and back region the spine was tender. On clinical examination generalized gingival enlargement was seen. The gingiva showed loss of stippling, loss of scalloping, inflammation and generalized recession. On palpation the gingiva was soft and there was spontaneous bleeding on probing. The multiple teeth were missing and patient gave history of exfoliation of those teeth in last 2 to 3 months. All the remaining teeth in the arch were grade 2 and grade 3 mobile. (Figure 1) After primary examination the provisional diagnosis of generalized periodontitis https://doi.org/10.18231/j.ijmi.2024.008 2581-382X/© 2024 Author(s), Published by Innovative Publication. 35