SHM Converge Scientific Abstract ePoster Gallery-A Hidden Diagnosis-Unraveling the Mystery of Bladder Mass and Fistula

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This case report describes an unusual presentation of multiple myeloma (MM), a cancer of plasma cells in the bone marrow that typically presents with the classic CRAB features: hypercalcemia, renal dysfunction, anemia, and bone lesions. Because MM can also spread outside the bone marrow, it may cause atypical symptoms and be mistaken for other diseases.<br /><br />A 70-year-old man with multiple chronic conditions presented with dysuria, gross hematuria, and abdominal pain. Initial workup showed a urinary tract infection and severe anemia, with hemoglobin of 6.0 g/dL, requiring multiple packed red blood cell transfusions. Bladder ultrasound suggested a possible diverticulum, but CT imaging of the abdomen and pelvis revealed a fistula connecting the bladder to a large posterior mass measuring 8.5 x 9.2 cm, as well as a second mass in the left iliac wing. Because of concern for malignancy, hematology-oncology was consulted. Although prostate cancer was initially suspected, PSA levels were low. A CT-guided biopsy of the iliac wing mass confirmed multiple myeloma, and electrophoresis supported the diagnosis. The patient was then transferred to a tertiary care center for further management.<br /><br />The report emphasizes that bladder involvement by MM is extremely rare, with only a few cases described in the literature. It highlights the importance of considering MM in the differential diagnosis when a bladder mass or unexplained hematuria is present, even if typical myeloma findings are absent. Early recognition of atypical presentations is essential to avoid misdiagnosis and ensure appropriate treatment.

Asset Subtitle

Jonathan D. Grube

Meta Tag

Author List Franklin Hernandez, Heena Patel, Jonathan D. Grube, Kathleen Mattingly, Mitra Chandan, Tiffany Sculthorpe

Category Clinical Vignettes

Concept Multiple Myeloma

Concept Clonal Plasma Cell Proliferation

Concept Extramedullary Disease

Concept CRAB Features

Concept Urinary Bladder

Distinguished Non-Finalist

Presenter Organization UCF/HCA Ocala Internal Medicine Residency

Presenting Author Jonathan D. Grube

Track Adult

Keywords

multiple myeloma

plasma cell cancer

gross hematuria

bladder fistula

bladder mass

iliac wing mass

severe anemia

urinary tract infection

atypical presentation

CT-guided biopsy

Multiple Myeloma

Clonal Plasma Cell Proliferation

Extramedullary Disease

CRAB Features

Urinary Bladder