Description of multiple myeloma cases and assessment of survival and mortality factors in Madagascar

INTRODUCTION

In Madagascar, the epidemiologic, therapeutic, and evolutionary aspects of multiple myeloma remain poorly understood. Our objectives were to describe the cases, report factors associated with mortality, and estimate patient survival.

PATIENTS AND METHOD

This was a retrospective descriptive and analytical study conducted in five teaching hospitals in Madagascar: HJRA and CENHOSOA (Antananarivo), CHUPZAGA (Mahajanga), CHUAT (Toamasina) and CHUT (Fianarantsoa). The study included patients diagnosed with multiple myeloma between January 1, 2010 and December 31, 2021.

RESULTS

Of the 11,374 cancer patients, 75 (0.66%) had multiple myeloma. The mean age of the patients was 59.9 years (±8.9) and the sex ratio was 1.5. Arterial hypertension was observed in 32% of the patients. The most common symptom of myeloma was bone pain (n = 48; 64%). Forty-six patients (61%) were diagnosed with stage III myeloma and 28 patients (37.3%) with stage IIIA myeloma according to the Durie-Salmon classification. Anemia, renal failure, hypercalcemia and fractures were present in 53%, 37%, 21% and 28% of cases, respectively. Fifty-four patients received specific treatment. The combination of melphalan-prednisone-thalidomide was used in 79.63% of cases, and one patient had received autologous stem cell transplantation. Eleven patients (14.67%) died. Chronic kidney disease (p = 0.009), smoking (p = 0.028) and two associated comorbidities (p = 0.035) were associated with mortality. The median overall survival was 45.5 months.

CONCLUSION

Patient survival is shorter than reported in the literature. The high mortality rate is due to comorbidities and limited access to recommended therapies.

Acute obstructive fungus ball pyelonephritis with Candida parapsilosis: A case report

Key Clinical Message

Fungal lithiasis is a rare but serious complication of candiduria. Frequent use of broad-spectrum antibiotics is a contributing factor in predisposed subjects. Two CBEUs are required to confirm the diagnosis of candiduria. Anti-fungal is found effective to eradicate the fungus ball besides surgery.

Abstract

Lithiasis by fungus ball is a serious complication of candiduria. Our case was a 58-year-old man who presented an acute obstructive pyelonephritis. Ultrasound revealed a left ureteral lithiasis. Biological examination revealed Candida parapsilosis. Antifungal was effective with good evolution. Broad-spectrum antibiotic therapy is one favoring factor.

Melanoma of unknown primary origin with skeletal muscle metastasis: a case report

BACKGROUND

Melanoma is usually discovered from an irregular skin patch or a modification of a preexisting patch. Cutaneous and lymph node metastases are common. Muscle metastases are rare. We report a case of melanoma with infiltration of the gluteus maximus, which had normal dermatological examination.

CASE PRESENTATION

A 43-year-old Malagasy man with no history of skin surgery was admitted with progressively worsening dyspnea. On admission, he presented with superior vena cava syndrome, painless cervical lymphadenopathy, and a painful swelling in the right buttock. Skin and mucous membrane examination did not reveal any abnormal or suspicious lesions. The biology was limited to a C-reactive protein of 40 mg/L, a white blood cell count of 23 G/L, and a lactate dehydrogenase level of 1705 U/L. The computed tomography scan showed several lymphadenopathies, compression of the superior vena cava, and a tissue mass at the expense of the gluteus maximus. Cervical lymph node biopsy and cytopuncture of the gluteus maximus were consistent with a secondary melanoma location. A stage IV melanoma of unknown primary origin, and with stage TxN3M1c associated with lymph node metastases and extension to the right gluteus maximus, was suggested.

CONCLUSIONS

Melanoma of unknown primary origin accounts for 3% of diagnosed melanomas. Diagnosis is difficult in the absence of a skin lesion. Patients are diagnosed with multiple metastases. Muscle involvement is unusual and may suggest a benign pathology. In this context, biopsy remains essential for diagnosis.

[Prevalence and etiological profiles of atypical localization venous thrombosis : A descriptive multicenter study]

INTRODUCTION

Venous thrombosis of unusual sites is much rarer than in the lower limbs and requires a rigorous etiological approach. The objective was to describe the clinical and progressive peculiarities of unusual localization venous thrombosis as well as their etiologies.

PATIENTS AND METHODS

Multicenter descriptive retrospective study of hospitalized patient records in the two large Hospital Centers, Antananarivo, Madagascar between 2017 and 2020 in which the diagnosis of unusual venous thrombosis was confirmed by imaging.

RESULTS

Seventy-seven thrombosis of atypical localization were present in fifty-nine patients identified. These were 24 men and 35 women with an M/F sex ratio of 0.68. The mean age of our patients was 49.4 years (± 16.76). Thrombosis seated in the majority of cases in the portal veins (n ​​= 27), cerebral veins (n ​​= 20), vena cava (n = 10), splenic veins (n ​​= 5), upper limbs and splenomearic trunk (each n = 4), Renal vein (n = 3). Venous thrombosis had occurred following tobacco intoxication (n = 15 cases); bed rest (n = 10); surgical intervention (n = 4). The aetiological assessment revealed a neoplastic origin in 27 cases (45.77%) dominated by hepatocellular carcinoma (n = 13). the antiphospholipid antibody syndrome dominates the case of autoimmune causes (n = 4). In terms of mortality, there were no deaths during the initial hospitalization. Eight patients had died, 4 of them due to hepatocellular carcinoma, 2 after surgery, and 1 each due to kidney cancer and liver cirrhosis. The mean follow-up period was 34.03 ± 51.5 days.

CONCLUSION

Unusual thrombosis, although rare, constitute a real challenge in the etiological approach. In clinical practice, the description of these thrombosis would allow us to understand their pathophysiological mechanism in order to plan the best management.

Pulmonary arteriovenous malformation revealing Osler-Weber-Rendu disease: A case report

Osler-Weber-Rendu disease is a genetic disease characterized by mucocutaneous and visceral telangiectasias. Pulmonary arteriovenous malformation is one of the main visceral complications revealing Osler-Weber-Rendu disease. The present case was a 34-year-old woman with exertional dyspnea and severe hypoxemia revealing pulmonary arteriovenous malformations on chest CT scan.

Light chain Amyloidosis (AL) associated with multiple myeloma revealed by peripheral bilateral polyarthritis: a case report

In chronic polyarthritis, the presence of macroglossia with absence of rheumatoid factor and anti-CCP antibodies may be suggestive of amyloid arthopathy. Clinical evaluation takes precedence over classification criteria.

[Huge aspergilloma developed within a zone of scleroderma-related pulmonary fibrosis]

In pulmonary aspergilloma, Aspergillus colonizes and proliferates as a saprophyte in deterged cavities deprived of local defense. Although pulmonary tuberculosis constitutes the one well-know predisposing factor, other causes can create favorable conditions. We describe a first published case of a huge aspergilloma which developed within a zone of pulmonary fibrosis secondary to systemic scleroderma. The patient was a 58-year-old woman in poor general health who experienced repeated episodes of hemoptysis and dyspnea. Physical examination disclosed sclerodactyly, generalized cutaneous sclerosis and Raynaud's phenomenon. There was no clinical history of pulmonary tuberculosis or bronchectasis. Aspergillosis serology was positive. Broncho-alveolar liquid was positive for Aspergillus fumigatus at direct examination and after culture. Immunological assessment confirmed scleroderma. The chest computed tomography scan showed a huge oblong-shaped opacity in the upper left lobe which had developed within a zone of pulmonary fibrosis. Medical management was instituted. The clinical course was marked by repeating hemoptysis and the stability of pulmonary lesions after two years. Management of scleroderma-related pulmonary aspergiloma remains difficult and complicated. Prognosis depends on the course of both conditions, scleroderma and aspergillosis.