Oral Manifestations of Malignant Immunoglobinopathy Hidden in Plain Sight - A Rare Case Report

RATIONALE: Radiolucent lesions over the angle–body region of the mandible are frequently difficult to diagnose but crucial to provide patient-centred care. PATIENT CONCERNS: An elderly female presented with a painless slow-growing swelling over her left lower face for one year, radiographically appearing as a well-defined unilocular radiolucency over the left body of the mandible. DIAGNOSIS: Aspiration was negative, and biopsy was inconclusive. Further imaging, bone marrow biopsy, immune profile and serum electrophoresis confirmed the diagnosis of multiple myeloma. TREATMENT: She was referred to Medical Oncology for chemotherapy of lenalidomide, bortezomib and dexamethasone regimen cycle that was repeated every 21 days. OUTCOMES: There was no increase in swelling, and radiographically ‘punched-out’ lesions were reduced significantly. TAKE-AWAY LESSONS: Maxillofacial clinicians should be attentive to the oral manifestations of underlying disease, have a high index of suspicion and start the treatment promptly to increase chances of a favourable outcome.