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Post Influenza Vaccination Case Study

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An unusual case of multiple myeloma being unmasked post influenza vaccination

A 65 year old female with diabetes and asthma presented with subjective chills, lethargy, arthralgias, and myalgias lasting over 2 days. She mentioned having received the inactivated influenza vaccine 5 days back. Vital signs were stable apart from sinus tachycardia (HR 143/min). Labs, including CBC and BMP, were within normal limits except for baseline normocytic anemia (Hb 10.7 g/dl). Serum calcium was 10.8 mg/dl. She was observed for a day, and was discharged home with supportive treatment. She presented a day later with persistent flu like symptoms. Labs were significant for a serum calcium being above 22 mg/dl, normal renal function, normal total protein, albumin, ACE levels, clear urine with no albuminuria, low …show more content…

24-hour urine collection revealed proteinuria (550 mg). A peripheral blood smear revealed rouleaux formation. CT scans of the chest, abdomen and pelvis revealed no obvious malignancy. Quantitative immunoglobulins were significant for elevated IgA (2415 mg/dl) and concurrent suppression of IgG and IgM levels. Quantitative serum light chain measurement revealed normal levels of kappa and lambda, with an elevated Kappa:Lambda ratio at 2:1. SPEP, UPEP, and serum immunofixation revealed IgA-Kappa Multiple Myeloma (MM). Given her significant-severe, symptomatic hypercalcemia; she was treated with aggressive intravenous crystalloids and loop diuretics, calcitonin, pamidronate; and a decision to perform early hemodialysis given her extremely high calcium levels. Her calcium subsequently normalized to 10.1 mg/dl. Bone-marrow biopsy with flow cytometry revealed intracytoplasmic kappa-restricted monoclonal plasma cells that occupied 40% of the marrow. Bone survey was negative for lytic lesions. Oncology started her on a chemotherapeutic regimen consisting of Bortezomib, Lenalidomide, dexamethasone along

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