{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:37:24Z","timestamp":1787168244905,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,7,15]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>We present the case of a 45-year-old man with a known history of sarcoidosis who presented with double vision and headache. On examination, he was found to have left abducens and hypoglossal nerve palsy. CT and then MRI demonstrated extensive osseous lesions with a large expansile mass involving the clivus bone and sphenoid sinus. Laboratory data were remarkable for normocytic anaemia, low anion gap and elevated total protein which raised the suspicion for multiple myeloma. Subsequent protein electrophoresis and immunofixation illustrated monoclonal spike of IgG lambda present in the gamma zone. This was followed by a bone marrow biopsy that demonstrated plasma cells compromising around 80% of marrow cellularity. Left sphenoidal mass biopsy was consistent with plasmacytoma. Based on these findings, the patient was initially started on palliative radiation to shrink the intracranial tumour and is currently undergoing induction chemotherapy.<\/jats:p>","DOI":"10.1136\/bcr-2020-235725","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T03:20:30Z","timestamp":1598325630000},"page":"e235725","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Diplopia as the initial symptom of multiple myeloma in a patient with sarcoidosis"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5795-461X","authenticated-orcid":false,"given":"Omid","family":"Yazdanpanah","sequence":"first","affiliation":[{"name":"Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasleen","family":"Kaur","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irfan","family":"Shafi","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Housam A","family":"Sarakbi","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"key":"2025082804395355000_13.8.e235725.1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcm077"},{"key":"2025082804395355000_13.8.e235725.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21590"},{"key":"2025082804395355000_13.8.e235725.3","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1001\/jamaoncol.2018.2128","article-title":"Global burden of multiple myeloma: a systematic analysis for the global burden of disease study 2016","volume":"4","author":"Cowan","year":"2018","journal-title":"JAMA Oncol"},{"key":"2025082804395355000_13.8.e235725.4","doi-asserted-by":"crossref","first-page":"15","DOI":"10.14740\/wjon1000w","article-title":"Hypoglossal nerve mononeuropathy as the first presenting symptom of progressing multiple myeloma","volume":"8","author":"Newman","year":"2017","journal-title":"World J Oncol"},{"key":"2025082804395355000_13.8.e235725.5","doi-asserted-by":"crossref","first-page":"e156","DOI":"10.1055\/s-0035-1554930","article-title":"Plasmacytoma of the clivus presenting as bilateral sixth nerve palsy","volume":"76","author":"Kalwani","year":"2015","journal-title":"J Neurol Surg Rep"},{"key":"2025082804395355000_13.8.e235725.6","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s10072-017-3167-3","article-title":"Sixth nerve and superior division of third nerve palsy due to intracranial extension of multiple myeloma. 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