Not an ordinary UTI: A case of multiple myeloma stage III with no manifestation of bone pain, hypercalcemia or osteolytic lesions

International Meeting on Clinical Case Reports

April 18-20, 2016 Dubai, UAE

Kavita B Kalra, Yue Shi and Zarah Lucas

University of Maryland, USA

Posters & Accepted Abstracts: J Clin Case Rep

Abstract :

A 63 year old AAM was admitted for dysuria and brown colored urine of 2 weeks� duration. He had no fever but had chills on and off. He reported a 23 lb weight loss and a decreased appetite. Workup on admission revealed anemia with a hemoglobin of 7.5 g/dL and renal insufficiency with creatinine as 1.67. He was treated with intravenous ceftriaxone which relieved his dysuria and discolored urine. However, his renal insufficiency persisted despite hydration and antibiotics. During his hospitalization, he was found to have worsening anemia, renal failure and weight loss. Due to his anemia and renal insufficiency, further workup was initiated. With the constellation of renal insufficiency stage III along with macrocytic anemia, multiple myeloma was suspected by the medicine team. Serum protein electrophoresis showed M protein of 4.4 g/dl with IgG kappa and free lambda on serum immunofixation. IgG was 6911 mg/dL. Kappa light chains were 622.3 mg/L with kappa/lambda ratio of 3.66. Subsequently, bone marrow biopsy showed 90% cellularity with 70-80% plasma cells that were kappa restricted. The following cytogenetics by FISH was reported: CCND1-IGH fusion, extra signal for chromosome 9 and loss of one copy of 13q14. Interestingly, the patient denied bone pain and had no lytic lesions on skeletal survey or MRI of the spine. He also did not have hypercalcemia; instead he actually has hypocalcemia with latest calcium level as 7.7 mg/dl. The patient was diagnosed with IgG kappa multiple myeloma, International Staging System Stage III, as his B2-microgobulin level is 10.3 mg/L.

Biography :

Email: yshi@iau.edu.lc