SHM Converge Scientific Abstract ePoster Gallery-Heavy Weight Challenger: Bias and Barriers in Plasmacytoma Diagnosis in a Morbidly Obese Patient

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This case report describes a 43-year-old man with diabetes, hypertension, and severe morbid obesity (595 pounds) who presented with recurrent falls, progressive leg weakness, sensory loss, bowel/bladder dysfunction, and signs of spinal cord compression. He initially sought care at multiple emergency departments, but his symptoms were repeatedly attributed to his weight and prior fibular fracture, contributing to diagnostic delay and perceived stigma.<br /><br />Workup showed a spiral right fibular fracture and CT evidence of a destructive lytic lesion at T8 extending to T7 and the right 8th rib, with additional rib lesions and severe spinal canal narrowing. Serum protein electrophoresis identified MGUS. However, MRI and CT myelogram were not possible because the patient exceeded equipment weight and size limits. Due to these technical barriers, he required a more invasive open biopsy combined with spinal decompression and fusion. Pathology confirmed lambda-restricted plasma cell myeloma, and a negative bone marrow aspirate supported the diagnosis of solitary bone plasmacytoma.<br /><br />Radiation therapy was deferred until his weight dropped below the treatment equipment limit of 500 pounds, and semaglutide was started to aid weight loss.<br /><br />The report emphasizes two major issues: first, obesity-related equipment limitations can delay diagnosis and force higher-risk procedures; second, weight bias in medicine may lead clinicians to misattribute serious symptoms to body habitus rather than pursuing further evaluation. The authors argue that patients with severe obesity need better access to imaging and treatment systems with higher weight capacity, as well as more awareness among clinicians to avoid delayed cancer diagnosis and worsened outcomes.

Asset Subtitle

Sonali Iyer

Meta Tag

Author List Mieraf Teka, Sonali Iyer, Uma Rao

Category Clinical Vignettes

Concept Solitary Bone Plasmacytoma

Concept Spinal Cord Compression

Concept Multiple Myeloma

Concept Severe Obesity

Concept Progressive Focal Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization UCI Health

Presenting Author Sonali Iyer

Track Adult

Keywords

severe obesity

spinal cord compression

solitary bone plasmacytoma

lambda-restricted plasma cell myeloma

diagnostic delay

weight bias

imaging limitations

open biopsy

spinal decompression

radiation therapy

Solitary Bone Plasmacytoma

Spinal Cord Compression

Multiple Myeloma

Severe Obesity

Progressive Focal Neurologic Deficit