An 80-year-old man being treated for multiple myeloma presente | MedRophine Science

An 80-year-old man being treated for multiple myeloma presented to the emergency department with a two-week history of low-grade fever and confusion. The patient was speechless during the examination and did not know the place and time. CT scans of the head and chest radiographs were normal. The patient became somewhat dizzy despite experimental treatment with broad-spectrum antibiotics while further evaluation was underway. MRI (magnetic resonance imaging) of the head also showed multiple amplifying cyclic lesions (Figure A). Lumbar puncture was performed. Cerebrospinal fluid (CSF) analysis showed 923 nucleated cells per microliter (reference range 0 to 5), 91% of which were neutrophils; The glucose level was 26 mg / dL (2 mmol / L; reference range 40 to 80 mg / dL [2.2 to 4.4 mmol / L]), and the total protein level was 147 Mg per deciliter (reference range, تا15 to 45).