What can hide a simple backache? A case report
Department of Emergency Medicine of Polyclinic Tor Vergata Rome
We report the case of a 40-year old man, who came to our observation in the Emergency Department, for the appearance of atraumatic right back pain, from one month, for which he was performing acupuncture cycle without benefits. The patient was in good health. Laboratory exams showed only normochromic normocitics anemia (haemoglobin 8,4 gr/dl), because the other required exams could not be assessed, due to the tendence to agglutinate quickly. A recent skeletal muscle ultrasound showed bone discontinuity of the last right ribs and a lumbosacral magnetic resonance was normal. The hematologist carried out peripheral blood smear, which appeared normal and in the suspicion of paraprotinemia, all the exams with cold agglutinins, cryoglobulins and protein eletcrophoresis dosages have been repeated. The protidogramma showed increase in total proteins (11,3 gr/dl) with a monoclonal peak in the gamma area (6 gr/dl) (Figure 1). The total body CT highlighted fracture of the twelfth dorsal vertebra and rarefaction of the sternum, humerus, first lumbar vertebra and scapular girdle. The following day patient was hospitalized to continue the treatment and investigation of the case.
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