A 71-year-old man presented with a 6-month history of back pain. His wife noted that he was frequently confused, slept m
Posted: Wed Apr 27, 2022 7:22 am
A 71-year-old man presented with a 6-month history of back pain.
His wife noted that he was frequently confused, slept much of the
day, and made occasional
nonsensical statements. On evaluation, he was anemic with a
hemoglobin (Hgb) level of 10 g/dL and a mean corpuscular volume
(MCV) of 91 fL. He had a
calcium level of 10.6 mg/dL (normal range is 8.8 to 10.5) with a
low albumin level of 2.6 g/dL and a corrected calcium of 11.7 g/dL.
The creatinine level was 1.1
g/dL. The patient was hydrated with normal saline and received
bisphosphonate infusion (pamidronate) that rapidly lowered the
calcium levels, and the
patient's mental status quickly improved over the following 3
days.
Serum protein electrophoresis revealed an M-spike measuring 4.7
g/dL. Immunoelectrophoresis revealed that the M-spike was composed
of an IgG-κ antibody.
His serum IgM level was 63 mg/dL, and the IgA level was 120 mg/dL.
The β2 microglobulin was 3.4 mg/dL. A 24-hour urine collection
demonstrated no protein.
The bone marrow was hypercellular with 70% plasma cells.
Cytogenetics showed normal male karyotype. A radiological skeletal
survey revealed classic lytic
lesions in the skull, pelvis, both arms, and both femurs, with
diffuse osteoporosis.
QUESTIONS
1. What major and minor criteria for multiple myeloma are met in
this patient?
His wife noted that he was frequently confused, slept much of the
day, and made occasional
nonsensical statements. On evaluation, he was anemic with a
hemoglobin (Hgb) level of 10 g/dL and a mean corpuscular volume
(MCV) of 91 fL. He had a
calcium level of 10.6 mg/dL (normal range is 8.8 to 10.5) with a
low albumin level of 2.6 g/dL and a corrected calcium of 11.7 g/dL.
The creatinine level was 1.1
g/dL. The patient was hydrated with normal saline and received
bisphosphonate infusion (pamidronate) that rapidly lowered the
calcium levels, and the
patient's mental status quickly improved over the following 3
days.
Serum protein electrophoresis revealed an M-spike measuring 4.7
g/dL. Immunoelectrophoresis revealed that the M-spike was composed
of an IgG-κ antibody.
His serum IgM level was 63 mg/dL, and the IgA level was 120 mg/dL.
The β2 microglobulin was 3.4 mg/dL. A 24-hour urine collection
demonstrated no protein.
The bone marrow was hypercellular with 70% plasma cells.
Cytogenetics showed normal male karyotype. A radiological skeletal
survey revealed classic lytic
lesions in the skull, pelvis, both arms, and both femurs, with
diffuse osteoporosis.
QUESTIONS
1. What major and minor criteria for multiple myeloma are met in
this patient?