SHM Converge Scientific Abstract ePoster Gallery-A Case of Multiple Myeloma That Highlights the Diagnostic Value of Slim Criteria in a Patient With Diffuse Bone Lesions

A Case of Multiple Myeloma That Highlights the Diagnostic Value of Slim Criteria in a Patient With Diffuse Bone Lesions

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This case report describes a 63-year-old woman who presented with worsening back pain, an L1 compression fracture, weight loss, constipation, and nausea. Initial laboratory studies were largely normal, except for an elevated total protein and protein gap, with normal calcium, creatinine, and hemoglobin levels. Imaging showed osteopenia, a T11 compression fracture, and a lytic lesion in the T12 pedicle. After she developed new rib pain during transfer for CT, repeat thoracic imaging revealed atraumatic rib fractures and innumerable diffuse lytic bone lesions. A bone marrow biopsy confirmed multiple myeloma.<br /><br />The report emphasizes the diagnostic importance of the SLiM criteria, which were added to the older CRAB framework in 2014. While CRAB focuses on end-organ damage such as hypercalcemia, renal dysfunction, anemia, and bone lesions, SLiM includes markers of early myeloma such as 60% clonal bone marrow plasma cells, a serum free light chain ratio of 100 or more, or at least one MRI-defined focal bone lesion. In this patient, systemic laboratory abnormalities were absent, but imaging findings strongly suggested malignancy.<br /><br />The discussion highlights that patients may have advanced skeletal involvement despite normal routine labs, and that reliance on CRAB criteria alone can delay diagnosis. The authors argue that hospitalists and clinicians should use the SLiM criteria alongside CRAB to detect multiple myeloma earlier and improve outcomes.

Asset Subtitle

Phyo Phyo Min Thu

Meta Tag

Author List Meghan Hartman, Nicholas S. Duca, Phyo Phyo Min Thu

Category Clinical Vignettes

Concept Multiple Myeloma

Concept CRAB Features

Concept SLiM Criteria

Concept Lytic Bone Lesions

Concept Pathologic Fracture

Distinguished Non-Finalist

Presenter Organization Penn State College of Medicine

Presenting Author Phyo Phyo Min Thu

Track Adult

Keywords

multiple myeloma

SLiM criteria

CRAB criteria

lytic bone lesions

compression fracture

bone marrow biopsy

osteopenia

protein gap

rib fractures

early diagnosis

Multiple Myeloma

CRAB Features

SLiM Criteria

Lytic Bone Lesions

Pathologic Fracture