Early-onset multiple myeloma: an illustrative case report.

OBJECTIVE: This case study describes a patient diagnosed with early manifestations of multiple myeloma and illustrates relevant aspects of differential diagnosis and the use of laboratory, radiologic, and advanced imaging techniques to aid in establishing the diagnosis and issues of management.

CLINICAL FEATURES: A 36-year-old male student experienced midback pain that occurred primarily at night in conjunction with fever and unexplained weight loss. Minor trauma induced a significant fracture and an occult fracture in the upper extremity. Physical examination revealed an elevated temperature indicating a fever of undetermined etiology. Plain radiographs revealed diffuse osteoporosis of the thoracic spine. Laboratory tests revealed anemia, hypercalcemia, and abnormal monoclonal paraprotein. Magnetic resonance imaging revealed a fracture with poor healing and an occult fracture in the upper extremity.

INTERVENTION AND OUTCOME: The patient was initially assessed for fever of undetermined etiology in association with nocturnal midback pain. Although considered a disease of the geriatric population, subsequent laboratory and radiologic evaluations established a diagnosis of early-onset multiple myeloma. Early recognition and referral with comanagement by an oncologist provided optimum care. Early-onset cases of multiple myeloma tend to have a more favorable response to treatment as compared with cases diagnosed in the geriatric population.

CONCLUSION: Multiple myeloma should be a consideration when a patient presents with nocturnal back pain and fever of undetermined etiology. Differentiating multiple myeloma from other causes of back pain is especially important in making management decisions. With a precise history and physical diagnosis, the diagnosis may be suspected, but confirmation must rely on ancillary investigations. Multiple myeloma is frequently accompanied by a poor prognosis, but early-onset cases generally respond more favorably to interventions.