Objective: AHyper calcemia induced parkinsonism is one of the reversible parkinsonism with few reported cases. To our knowledge, Parkinsonism as a presenting feature of multiple myeloma was not reported in the literature.We describe an elderly man presented with parkinsonian features  and hypercalcemia subsequently diagnosed as multiple myeloma

Background: 65 year old male presented with complaints of slurring of speech for 2 weeks with Slowness of activity, difficulty in walking and swollowing. He had a background history of hypertension on thiazides. On examination he had bradykinesia, rigidity and  festinant gait  His baseline investigations showed hyper calcemia  and  hypokalemia with mildly elevated in renal parameters  . MRI brain showed microvascular ischemic changes. On further evaluation, skull X-Ray  showed osteolytic  lesions, serum protien electrophorosis  showed M band in gamma region and immunofixation showed IgG in lambda region. CD 135 was elevated. His serum parathyroid harmone level,  PTH related protien, urine bence jonce protiens, serum ACE level  and  thyroid profiles  were normal . He was diagnosed as multiple myeloma and treated with thalidomide. Patient gradually improved and his parkinsonian symptoms disappeared once his hypercalcemia was controlled.

Methods: Not applicable

Results: Our patient presented with features of Parkinsonism with hypercalcemia subsequently diagnosed as multiple myeloma.  The precise mechanism of parkinsonism in our patient is unknown. Hyper calcemia induced neurotoxicity is independent calcium toxic effect. It seems likely that there may be some kind of transitory functional influence of calcium on the dopamine turnover or post-synaptic dopamine receptor site, leading to Parkinsonism.

Conclusions: Multiple myeloma/ hypercalcemia induced parkinsonism is a uncommon entity.  Early diagnosis and appropriate treatment prevents progression

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MDS Abstracts - https://www.mdsabstracts.org/abstract/multiple-myeloma-induced-parkinsonism/