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Auer rod-like inclusions in plasma cells in multiple myeloma
  1. Wai Khoon Ho,
  2. Daniela Zantomio
  1. Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Wai Khoon Ho, Department of Haematology, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia; wai.ho{at}

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A female patient presented with bone pain. Bone scan demonstrated a focal lesion in the left iliac crest, which was confirmed subsequently as a lytic lesion on CT scanning. Core biopsy showed plasmacytoid cells that were strongly positive for CD138 with extensive strong κ light chain immunostaining. Haemoglobin was 124 g/L, white cell count 5.4×109/L, neutrophils 3.0×109/L, platelets 300×109/L and erythrocyte sedimentation rate 7 mm/h. Serum creatinine was 90 μmol/L; adjusted serum calcium was 2.50 mmol/L with normal serum phosphate and bicarbonate levels and anion gap. Serum protein electrophoresis demonstrated monoclonal IgG κ of 4 g/L and free κ light chain of 5 g/L. Urinary Bence–Jones protein measured 2.45 g/L comprising free κ light chains. Serum free κ light chains were >4275.0 mg/L (3.3–19.4) and λ light chains 9.4 mg/L (5.7–26.3) with β2-microglobulin 5.4 mg/L (0.80–3.00). Skeletal survey demonstrated multiple lucencies in both femora, humeri, ribs, thoracic spine, calvarium and left iliac bone.

Six years previously, she …

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