iatroX Rounds #4
The clues
- 1
A 68-year-old man presents with persistent lower back pain that has been worsening over the last four months.
- 2
He reports feeling increasingly fatigued and notes that he has required two courses of antibiotics for chest infections in the past year.
- 3
Blood results show a normocytic anaemia and a significantly raised erythrocyte sedimentation rate, though the C-reactive protein is normal.
- 4
On examination there is focal tenderness over the lumbar spine and his adjusted calcium is elevated at 2.85 mmol/L.
- 5
A lateral skull X-ray demonstrates multiple well-defined, small lucent lesions creating a characteristic pepper-pot appearance.
- 6
Serum protein electrophoresis shows a dense monoclonal band in the gamma-globulin region and urine contains free light chains.
<p><strong>Multiple myeloma</strong> is a haematological malignancy characterised by the clonal proliferation of plasma cells within the bone marrow. It typically presents in older adults with symptoms relating to bone destruction, renal impairment, and marrow infiltration.</p>
- Hypercalcaemia and renal impairment
- Normocytic anaemia
- Osteolytic bone lesions
- Monoclonal gammopathy
for education and entertainment. not medical advice.