An unusual case of multiple myeloma

The case concerns the unusual presentation of a non-secretory multiple myeloma with diarrhoea secondary to large bowel infiltration. In December 2009, a 74-year-old lady presented to hospital and complained of a two year history of intermittent diarrhoea which had been worsening over a three month period. She also had sustained a deep vein thrombosis and was investigated for pulmonary embolism. Routine blood investigations showed a raised ESR & CRP and a normochromic normocytic anaemia. Urea and electrolytes, liver function tests, calcium, phosphate and albumin where all normal, creatinine was elevated. Serum protein electrophoresis was normal at presentation. Chest X-ray revealed lytic rib and vertebral lesions which were followed by CT scan and MRI. Colonic biopsy revealed a plasma cell infiltration and rib trucut biopsy revealed plasmacytoma. Bone marrow biopsy confirmed Multiple Myeloma. This is a plasma cell disorder that characterised by abnormal proliferation and accumulation in the bone marrow. Typically it is accompanied by monoclonal protein in the serum and/ or urine and consequent tissue damage such as kidney failure and pathological fractures due to bone damage.peer-reviewe

The outcome of the follow-up of consolidations on chest radiographs in a Maltese population, presenting from the community, aged 50 or over : a retrospective study

Background: The British Thoracic Society (BTS) guidelines for community-acquired pneumonia (CAP) suggest a repeat chest radiograph 6 weeks after treatment for patients over the age of 50 to screen for lung malignancy. The benefit of this practice is not well determined. Method: We conducted a retrospective study involving patients from the community over 50 years old with consolidations on chest radiography. These patients presented in Mater Dei Hospital, Gozo General Hospital and Maltese Health Centres during the months of January 2013-2017 and August 2013-2016. The occurrence of follow-up imaging and subsequent diagnosis of lung malignancy was documented. All chest radiographs were reviewed by a radiologist. Results: 402 patients met our inclusion criteria. Follow-up imaging was done in 214 patients (53.2%) within 12 weeks. There was no statistical significance in the follow-up rates when matched for the presenting month, whether radiologists recommended repeat imaging, whether patients were admitted to hospital, and for the patients’ age and gender. The diagnostic yield of lung malignancy was 1.74% (7 patients) within 12 weeks with all malignancies being at an advanced stage at diagnosis (lowest stage being IIIA) when detected. All seven patients had a smoking history. Conclusion: 53.2% of community-acquired pneumonia patients over the age of 50 had follow-up imaging within 12 weeks. No clinical variables explaining this low rate could be identified. This practice results in a low diagnostic yield. Moreover, the diagnosis of lung malignancy is achieved at an advanced stage, making it a poor screening tool.peer-reviewe

Treating Acinetobacter lwoffi peritonitis in a patient undergoing peritoneal dialysis

Acinetobacter spp are increasingly recognized as an important cause of nosocomial infections, especially in relation with indwelling catheters. They are ubiquitous, gram negative bacilli, being normally found on the skin and oropharynx and are notorious for their broad antimicrobial resistance pattern. Only a few cases of peritoneal dialysis-associated Acinetobacter lwoffi peritonitis have been reported with most of the affected patients being diabetic and/or immunosuppressed. Literature concerning the management of non-pseudomonas gram negative peritonitis is scarce. We describe a case of a sixty-six year old gentleman with end stage kidney disease due to autosomal dominant polycystic kidney disease on Automated Peritoneal Dialysis who was successfully treated for Acinetobacter lwoffi peritonitis. The patient did very well, did not require hospital admission and the peritoneal catheter remained in-situ.peer-reviewe