LIGHT-CHAIN MYELOMA WITH ORO-PHARYNGEAL AMYLOIDOSIS PRESENTING AS BULBAR PARALYSIS

A 53-year old woman developed slowly progressive dysarthria, mild enla rgement of the tongue and dysphagia since 1 year ago. All neurological differential diagnoses that could have explained the bulbar symptoms were excluded. The swallowing sequence was pathologic and immunoglobul ins were markedly reduced. A bone marrow biopsy revealed light chain m yeloma grade III. Amyloid deposits were found in the tongue but not in the kidneys. Oro-pharyngeal amyloidosis was held responsible for the described complaints. It is concluded that multiple myeloma must be co nsidered in the differential diagnosis of bulbar paralysis and that bi opsy of specific lesions is necessary to confirm local amyloidosis. (C ) 1997 Elsevier Science B.V.