Case history
Case history #1
A 60-year-old previously healthy man presents with 2-3 months of back pain. Over the last 3 weeks, he has developed a cough and increasing fatigue. On examination he has evidence of pneumonia and osteolytic lesions on radiography. Laboratory tests reveal anemia associated with the presence of a monoclonal protein.
Case history #2
A 45-year-old woman presents to the emergency department with nausea, vomiting, and confusion. She has a history of low back pain of 6 months' duration and increasing sciatic pain in the last 2 weeks. On physical exam, the patient is pale and dehydrated with bone tenderness in the lumbar region. Neurologic exam reveals an upgoing plantar reflex on the left foot with intact power in all muscle groups and at all joints. Magnetic resonance imaging reveals an L5 compression fracture. This is associated with hypercalcemia and renal insufficiency.
Other presentations
Symptoms of bone pain (typically localized to the back) and anemia are the most common presenting features, affecting 60% to 70% of patients.[5][6] Other features include renal insufficiency, hypercalcemia, and symptoms associated with infection.[5][6][7] Monoclonal proteins are sometimes seen on serum electrophoresis in asymptomatic patients because of increased globulin fractions.
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