SHM Converge Scientific Abstract ePoster Gallery-From Silent Lab Clue to Life-Changing Diagnosis: A Hospitalist's Detection of Early Multiple Myeloma

Pdf Summary

This case highlights how a hospitalist can detect early multiple myeloma during an admission for an unrelated problem. An 80-year-old man was hospitalized for heart failure exacerbation and improved with diuretics, but routine labs revealed mild hypercalcemia, a falling hemoglobin level, and an elevated protein gap. Prior imaging also showed rib lucencies that had been attributed to osteopenia. Although he lacked classic CRAB symptoms, these subtle findings raised concern for plasma cell dyscrasia.<br /><br />Further evaluation showed an IgG kappa monoclonal spike on SPEP with immunofixation, an M-protein of 3.4 g/dL, and a markedly abnormal kappa/lambda ratio of 74. Bone marrow biopsy confirmed 80% plasma cell infiltration with kappa light chain restriction and hyperdiploid cytogenetics, establishing the diagnosis of IgG kappa multiple myeloma. Treatment with daratumumab and bortezomib was started, leading to biochemical improvement and clinical stability.<br /><br />The case emphasizes that multiple myeloma is often diagnosed late, after end-organ damage has occurred, but early clues such as mild hypercalcemia, unexplained anemia, and widened protein gap may appear before classic CRAB features. Hospitalists are uniquely positioned to recognize these patterns during routine admissions and initiate timely workup. The report underscores the importance of diagnostic vigilance and shows how careful interpretation of ordinary lab abnormalities can lead to an earlier, life-changing diagnosis.

Asset Subtitle

Gauri Pikale

Meta Tag

Author List Farah Zahra, Gauri Pikale, Joaquim Noguer

Category Clinical Vignettes

Concept Multiple Myeloma

Concept CRAB Features

Concept Plasma Cell Dyscrasia

Concept Serum Protein Electrophoresis

Concept Free Light Chain

Distinguished Non-Finalist

Presenter Organization Northwestern Medicine McHenry Hospital/Rosalind Franklin University of Medicine and Science

Presenting Author Gauri Pikale

Track Adult

Keywords

multiple myeloma

IgG kappa

plasma cell dyscrasia

hypercalcemia

anemia

protein gap

SPEP

bone marrow biopsy

hospitalist diagnosis

CRAB symptoms

Multiple Myeloma

CRAB Features

Plasma Cell Dyscrasia

Serum Protein Electrophoresis

Free Light Chain