Multiple Myeloma in a Patient with Sarcoidosis and Heavy Proteinuria: A Case Report

The present case is of 44-year-old woman who was a known case of sarcoidosis revealed granulomatous inflammation without caseafication. She also reported to suffer from proteinuria about 2 g/day, which was reported as Focal Segmental Glomerulosclerosis (FSGS) secondary to sarcoidosis after renal biopsy and thorough evaluation. Skeletal survey showed multiple lytic lesions in her skull, ribs, vertebra and iliac bone. The patient fully met diagnostic criteria for symptomatic Multiple Myeloma (MM) and chemotherapy was started with Velcade, Cyclophosphamide and Dexamethasone. Having completed chemotherapy, bone marrow plasma cells reached 8% and there were no peak of the serum or urine protein. Our patient is the first report of correlation of three diseases of Sarcoidosis and MM together and FSGS. Immune system impairment may be the main predisposing factor. The relationship between sarcoidosis and MM is unclear. Since in sarcoidosis, impaired immune system is involved, it predisposes developing malignancies in sarcoidosis. It is suggested that two important factors i.e. aneuploidy in the granuloma and peripheral blood lymphocytes can cause haematologic malignancy via developing genetic instability.