{"id":26659,"date":"2025-06-02T09:38:00","date_gmt":"2025-06-02T07:38:00","guid":{"rendered":"https:\/\/www.icscyl.com\/mileon\/?p=26659"},"modified":"2025-05-31T17:48:02","modified_gmt":"2025-05-31T15:48:02","slug":"sesion-clinica-8-2025-mieloma-multiple","status":"publish","type":"post","link":"https:\/\/www.icscyl.com\/mileon\/sesiones-clinicas\/2025-06-02\/sesion-clinica-8-2025-mieloma-multiple\/","title":{"rendered":"Sesi\u00f3n cl\u00ednica 8\/2025: mieloma m\u00faltiple"},"content":{"rendered":"<div class=\"wp-block-image\">\n<figure class=\"alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"640\" height=\"401\" src=\"https:\/\/www.icscyl.com\/mileon\/wp-content\/uploads\/2023\/03\/turn-on-gf94c39300_640.jpg\" alt=\"\" class=\"wp-image-25483\" style=\"width:195px;height:auto\" srcset=\"https:\/\/www.icscyl.com\/mileon\/wp-content\/uploads\/2023\/03\/turn-on-gf94c39300_640.jpg 640w, https:\/\/www.icscyl.com\/mileon\/wp-content\/uploads\/2023\/03\/turn-on-gf94c39300_640-300x188.jpg 300w, https:\/\/www.icscyl.com\/mileon\/wp-content\/uploads\/2023\/03\/turn-on-gf94c39300_640-624x391.jpg 624w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/figure>\n<\/div>\n\n\n<p>En la sesi\u00f3n cl\u00ednica del 30 de abril de 2025, los doctores Carlos Lorente (R3 de Medicina Interna) e Isabel Muinelo, presentaron un caso cl\u00ednico que ilustra la complejidad diagn\u00f3stica en un contexto de fiebre, anemia y deterioro de la funci\u00f3n renal, en una paciente inicialmente sospechosa de padecer tuberculosis o un tumor ginecol\u00f3gico. El caso concluy\u00f3 con el diagn\u00f3stico de mieloma m\u00faltiple, una enfermedad infrecuente en pacientes j\u00f3venes, cuya presentaci\u00f3n cl\u00ednica inicial puede ser muy variada. El Dr. Lorente plante\u00f3 un extenso diagn\u00f3stico diferencial que incluy\u00f3 tuberculosis extrapulmonar, procesos ginecol\u00f3gicos tumorales, infecciones parasitarias, vasculitis sist\u00e9micas, linfoma, y diversas causas de anemia hemol\u00edtica, dada la elevaci\u00f3n de LDH. Se valor\u00f3 tambi\u00e9n la posibilidad de mieloma m\u00faltiple, poco frecuente en menores de 65 a\u00f1os, pero con mayor prevalencia en personas de raza negra, como la paciente.<\/p>\n\n\n\n<p>El mielograma confirm\u00f3 plasmocitosis del 30,4% con morfolog\u00eda an\u00f3mala. Adem\u00e1s, la determinaci\u00f3n de cadenas ligeras kappa en orina mostr\u00f3 un cociente kappa\/lambda extremadamente elevado, caracter\u00edstico del mieloma de cadenas ligeras. El caso cumpl\u00eda criterios CRAB (anemia, insuficiencia renal, lesiones \u00f3seas) y estadio ISS III. Se descart\u00f3 amiloidosis mediante PAAF de grasa subcut\u00e1nea. Como tratamiento, se inici\u00f3 quimioterapia con esquema Velcade + lenalidomida, tras suspender daratumumab por empeoramiento de la funci\u00f3n renal. Su presentaci\u00f3n conjunta est\u00e1 disponible a continuaci\u00f3n.<\/p>\n\n\n\n<div class=\"wp-block-file\"><a id=\"wp-block-file--media-17360448-c0fa-4ecb-8a60-f343d41708c3\" href=\"https:\/\/www.icscyl.com\/mileon\/wp-content\/uploads\/2025\/05\/Dres-Lorente-y-Muinelo-sesclin-Abr25.pdf\">Dres Lorente y Muinelo sesclin Abr25<\/a><a href=\"https:\/\/www.icscyl.com\/mileon\/wp-content\/uploads\/2025\/05\/Dres-Lorente-y-Muinelo-sesclin-Abr25.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-17360448-c0fa-4ecb-8a60-f343d41708c3\">Descarga<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>En la sesi\u00f3n cl\u00ednica del 30 de abril de 2025, los doctores Carlos Lorente (R3 de Medicina Interna) e Isabel Muinelo, presentaron un caso cl\u00ednico que ilustra la complejidad diagn\u00f3stica en un contexto de fiebre, anemia y deterioro de la funci\u00f3n renal, en una paciente inicialmente sospechosa de padecer tuberculosis o un tumor ginecol\u00f3gico. El [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[723],"tags":[1110,947],"class_list":["post-26659","post","type-post","status-publish","format-standard","hentry","category-sesiones-clinicas","tag-lorente","tag-muinelo"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/posts\/26659","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/comments?post=26659"}],"version-history":[{"count":1,"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/posts\/26659\/revisions"}],"predecessor-version":[{"id":26661,"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/posts\/26659\/revisions\/26661"}],"wp:attachment":[{"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/media?parent=26659"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/categories?post=26659"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.icscyl.com\/mileon\/wp-json\/wp\/v2\/tags?post=26659"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}