MULTİPLE MİYELOMALI BİR HASTADA SESSİZ STERNUM ÇÖKMESİ: SPONTAN KIRIK OLGUSU

Öz

Özet Giriş: Sternal kırıklar genellikle yüksek enerjili travmalara bağlı gelişir; spontan sternal kırıklar ise oldukça nadirdir ve sıklıkla gözden kaçırılır. Plazma hücre malignitesi olan Multipl Miyelom (MM), litik kemik lezyonlarına neden olarak patolojik kırık riskini artırır. Bu durum, düz kemikler olan sternum gibi bölgelerde de spontan kırıklara zemin hazırlayabilir. Olgu Sunumu: Yaklaşık 8 yıldır MM tanısıyla takip edilen ve daha önce otolog kök hücre nakli yapılan 50’li yaşlarında erkek hasta, skapulotorasik bölgede başlayan ve öne doğru yayılan ağrı şikayetiyle başvurdu. Herhangi bir travma öyküsü bulunmamaktaydı. Laboratuvar bulguları normal sınırlardaydı. Aralık 2023 tarihli toraks BT’sinde sternumda herhangi bir patoloji izlenmezken; Mart ve Nisan 2024 tarihli takip görüntülemelerinde ilerleyici sternum lizisi ve deplase kırık saptandı. Nörolojik ya da kardiyopulmoner komplikasyon olmaması ve genel klinik durumun stabil olması nedeniyle hasta konservatif olarak takip edildi. Sonuç: Bu olgu, MM’ye bağlı litik lezyonların sternum gibi düz kemiklerde spontan kırıklara neden olabileceğini ortaya koymaktadır. MM tanılı ve yeni başlayan göğüs ağrısı olan hastalarda travma öyküsü olmasa dahi patolojik kırık olasılığı göz önünde bulundurulmalıdır. Erken tanı, komplikasyonların önlenmesi ve gereksiz girişimlerden kaçınılması açısından kritik öneme sahiptir.

Anahtar Kelimeler

• Multipl Miyelom
• Spontan Kırık
• Sternum Kırığı
• Litik Kemik Lezyonu
• Patolojik Kırık
• Travma Dışı Göğüs Ağrıs

SILENT STERNUM COLLAPSE IN A MYELOMA PATIENT: A CASE OF SPONTANEOUS FRACTURE

Öz

Abstract Introduction: Sternal fractures are typically associated with high-energy trauma, while spontaneous occurrences are rare and often overlooked. Multiple myeloma (MM), a hematologic malignancy characterized by plasma cell proliferation and lytic bone destruction, increases the risk of pathological fractures, even in flat bones such as the sternum. Case Report: A male patient in his 50s with an 8-year history of MM and prior autologous stem cell transplantation presented with scapulothoracic pain radiating anteriorly. He denied any history of trauma. Laboratory findings were unremarkable. Retrospective evaluation of serial chest computed tomography (CT) scans revealed no abnormalities in December 2023. However, subsequent scans from March and April 2024 demonstrated progressive sternal lysis and a displaced fracture. Due to the patient’s overall clinical status and absence of neurological or cardiopulmonary compromise, conservative management was chosen. Conclusion: This case underscores the importance of considering spontaneous pathological fractures in MM patients, particularly when new chest pain arises without trauma. Early recognition through imaging is crucial to prevent misdiagnosis, avoid unnecessary interventions, and guide appropriate management strategies.

Anahtar Kelimeler

• Multiple Myeloma
• Spontaneous Fracture
• Sternal Fracture
• Lytic Bone Lesion
• Non-traumatic Chest Pain

Destekleyen Kurum

NO

Etik Beyan

Written informed consent was obtained from the patient for the publication of this case report

Teşekkür

Dear Editor, We are pleased to submit our manuscript entitled “Silent Sternum Collapse in a Myeloma Patient: A Case of Spontaneous Fracture” for your consideration as a case report in the Journal of Emergency Medicine. This manuscript describes a rare and diagnostically challenging case of a spontaneous, non-traumatic sternal fracture in a patient with long-standing multiple myeloma. The case highlights the importance of considering pathological fractures in hematologic malignancy patients presenting with chest pain. We believe this report will be a valuable addition to the literature and may enhance clinical awareness of similar presentations in emergency settings. We confirm that the manuscript is original, has not been published elsewhere, and is not under consideration by any other journal. Written informed consent was obtained from the patient for publication. All authors have reviewed and approved the final version of the manuscript. We sincerely thank you for the opportunity to present this unique case to your readership and for your time and consideration. Yours sincerely, Dr. Ömer Esmez

Kaynakça

1. 1. Khoriati AA, Rajakulasingam R, Shah R. Sternal fractures and their management. J Emerg Trauma Shock. 2013;6(2):113-116. doi: 10.4103/0974-2700.110763
2. 2. Cobanoglu U, Hiz O, Sayir F, Ediz L, Sehitoğullari A. Traumatic and atraumatic sternum fractures: analysis of 13 cases. Turk Thorac J. 2012;13(4):171-175.doi: 10.5152/ttd.2012.31
3. 3. Sarbay I, Dogan H. A rarecause of chestpain: spontaneous sternum fracture. J Emerg Crit Care Med. 2018;2:6.doi: 10.21037/jeccm.2018
4. 4. Mukkamalla SKR, Malipeddi D. Myeloma bone disease: a comprehensive review. Int J Mol Sci. 2021;22(12):6208. doi:10.3390/ijms22126208
5. 5. Reuling EMB, Jakma TS, Schnater JM, Westerweel PE. Spontaneous sternal fracture due to multiple myelom are quiring extensive surgicalrepair. BMJ Case Rep. 2015; 2015: bcr2015211498. doi:10.1136/bcr-2015-211498
6. 6. Geng Q, Li J, Li X, Zhang W, Zhang G, Ge L, Liang L. A casereport: Non secretory multiple myelom apresenting with bone pain. Medicine (Baltimore). 2024;103(5):e36951. doi:10.1097/MD.0000000000036951
7. 7. Perez MR, Rodriguez RM, Baumann BM, Langdorf MI, Anglin D, Bradley RN, et al. Sternal fracture in theage of pan-scan. Injury. 2015;46(7):1324-1327. doi:10.1016/j. injury.2015.04.007
8. 8. Tuncer K, Kose M, Ogul H. Spontaneous stair like fracture of sternum in multiple myeloma. Joint Bone Spine. 2023;90(4):105553. doi:10.1016/j.jbspin.2023.105553

9. 9. Cowan AJ, Green DJ, Kwok M, Lee S, Coffey DG, Holmberg LA, et al. Diagnosis and management of multiple myeloma: a review. JAMA. 2022;327(5):464-477. doi:10.1001/ jama.2021.23223