Vanishing Bone As the Presenting Feature of Multiple Myeloma

A 47-year-old female presented with a minimally displaced fracture of proximal one-third of the shaft of the humerus that she suffered two months before and managed conservatively with a Plaster of Paris (POP) slab. An X-ray performed after six weeks showed complete vanishing of the proximal third portion of humerus due to massive osteolysis and generalized osteopenia. On examination, there was a soft tissue swelling over the proximal part of the left arm with painful and limited range of motion of the left shoulder. Biopsy of the lesion revealed neoplastic proliferation of plasmacytoid cells with binucleation showing strong, diffuse immunoreactivity to CD-138 and MUM-1, and thus a diagnosis of multiple myeloma was made. Typically, bone lesions in multiple myeloma present as multiple, well-defined "punched out" osteolytic lesions rather than complete vanishing of bone. The purpose of this report is to increase the awareness of this presenting feature of multiple myeloma.