Unveiling the Intruder: Multiple Myeloma Presenting in Oral Cavity

Abstract

Background: Multiple myeloma is a common hematological malignancy with varied clinical presentations. Oral manifestations are uncommon and may delay diagnosis because they mimic other oral and maxillofacial pathologies. This report highlights a rare presentation of multiple myeloma involving the oral cavity and emphasizes the importance of careful oral examination.

Case Report: A 60-year-old female presented with an eight-month history of painful swelling in the left gingivobuccal sulcus associated with generalized myalgia and backache. Imaging revealed multiple lytic lesions involving the calvarium, maxilla, mandible, and sphenoid with an expansile lesion in the maxillary sinus. Initial investigations, including urine Bence Jones protein, serum electrophoresis, and biopsy, were inconclusive. Fine-needle aspiration cytology and endoscopic biopsy demonstrated plasmacytoma with positive CD138 and kappa light chain expression. Bone marrow biopsy showing 30% plasma cells confirmed the diagnosis of multiple myeloma. The patient received chemotherapy, radiotherapy, and plasma cell transfusion but subsequently developed deep vein thrombosis and died three months later.

Conclusion: Multiple myeloma may rarely present initially as an oral cavity lesion. Because several differential diagnoses exist, comprehensive clinical evaluation and a combination of radiological, histopathological, and hematological investigations are essential for early diagnosis and timely management.