Case 45261

Presentation of Case First admission. A seventy-year-old man was admitted to the hospital because of epistaxes and nasal obstruction of six months' duration.A plasmacytoma was excised from the posteroinferior portion of the left side of the nasal cavity. Subsequently, a course of 4000 r of x-ray therapy was given. The urine was normal at that time, as were the hemoglobin and white-cell count.The patient's brother had died of multiple myeloma after a rapid course of the disease. Second admission (eight years later). The patient remained well until four years after discharge, when persistent hoarseness and cough developed. One . . .