title: [Bacterial meningitis as first manifestation of a patient with multiple myeloma. A case report].
abstract: BACKGROUND
  Multiple myeloma (MM) is a plasma cell neoplasm characterized by clonal proliferation of plasma cells in the bone marrow and monoclonal protein in serum and/or urine in association to target organ damage. Infections are a frequent finding and they are multifactorial and presented mainly in the first months of diagnosis.
  
  
  METHODS
  We reported the case of a 62 years old woman, with impaired alertness, drowsiness, fever, incoherent speech and meningeal signs, cerebrospinal fluid showed polymorphonuclear pleocytosis, hypoglycorrhachia, hyperproteinorrhachia, and Gram positive cocci, she received antibiotic treatment and improved until resolution of symptoms, however when conscious she referred paraplegia and back pain, anemia, lymphopenia, elevation of serum globulins, calcium and CRP. The bone marrow aspiration showed infiltration by plasma cells and the serum protein electrophoresis and immunofixation showed the presence of monoclonal gamma IgA lambda spike. Smears of cerebrospinal fluid was absent of plasma cells. The diagnosis of multiple myeloma stage III-A is established.
  
  
  CONCLUSIONS
  Association between (MM) and infection is high and although rare as first manifestation of MM, should take focus and high suspicion in patients with suggestive manifestations not explained by the infection itself.
authors.affiliation: Servicio de Medicina Interna, Hospital General de Tijuana, Secretaría de Salud del Estado de Baja California, Tijuana, Baja California, México. sgalveza@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Gálvez-Acosta
authors.forename: César Enrique
authors.initials: CE
authors.lastname: Garnica-Camacho
mesh_terms: D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000209:etiology*; D006095:Gram-Positive Cocci / Q000302:isolation & purification*; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis*
keywords: Bacterial infections; Meningitis; Multiple myeloma; Plasma cells