Abstract
The clinical course and autopsy findings of a male patient, 51 years of age, with multiple myeloma of an atypical type were reported. A number of myeloma cells were observed in smears of bone marrow aspirate from both the sternum and the right iliac crest. X-ray films of the skull and other bones revealed many punched-out areas. Serum total protein was about 5 g/dl and no proteinuria was detected throughout his clinical course. No increase was observed in any of serum globulin fractions. Concentration of serum gamma-globulin fraction was less than 2 per cent of the total protein. M-bow formation was not observed in immunoelectrophoretic analysis of either the patient's serum or urine against anti-IgG, -IgA, -IgM, -IgD, -IgE and-light chain of both κ and λ sera. Incorporation rate of 75Se-methionine into the gamma-globulin fraction was low and delayed as compared with those of normal persons and of several patients with typical IgG-myeloma. He died of cholestatic jaundice due to myelomatous lesions in the gallbladder and adjacent lymph nodes, and congestive heart failure. Autopsy revealed a number of myeloma nodules in the bone marrow, liver, spleen, pancreas, gallbladder, kidneys and lymph nodes. In addition, numerous miliary to pea-sized lesions of tuberculosis were observed in the lungs.
