SHM Converge Scientific Abstract ePoster Gallery-Post-Discharge Follow-Up for Diagnosis of Multiple Myeloma in a Patient Presenting With Recurrent Infection

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This case report describes a 47-year-old bodybuilder with a long history of injectable testosterone use who presented with recurrent thigh cellulitis, worsening pain at an injection site, and acute kidney injury. Initial imaging suggested soft-tissue infection, but MRI also showed prominent red marrow hyperplasia in the femur and pelvis. Because of persistent deep hip pain, renal dysfunction, and subtle lab abnormalities, clinicians broadened the differential to include plasma cell dyscrasia and ordered serum and urine protein electrophoresis before discharge.<br /><br />The urine protein electrophoresis later returned after discharge showing an M-protein spike with monoclonal lambda light chains, raising concern for multiple myeloma. Although the primary care team addressed several issues at follow-up, this result was initially overlooked and required direct communication to ensure further evaluation. Additional testing confirmed the suspicion for multiple myeloma, and PET-CT demonstrated multiple FDG-avid lesions in the spine, pelvis, ribs, and left second rib.<br /><br />Because there was no dedicated hematologist available in the patient’s system and referral delays were expected, care coordination was used to expedite remaining workup and hematology follow-up. Before treatment could begin, the patient was readmitted with pain crisis and developed myeloma cast nephropathy. He was transferred to inpatient hematology and urgently treated with plasmapheresis, daratumumab, and CyBorD, after which renal function improved.<br /><br />The case highlights how multiple modest abnormalities—recurrent infection, bone pain, kidney injury, and marrow changes—can collectively signal occult multiple myeloma. It also emphasizes the importance of reliable follow-up systems for tests pending at discharge, since delayed recognition of actionable results can affect diagnosis and treatment.

Asset Subtitle

Elyse Conley

Meta Tag

Author List Elyse Conley

Category Clinical Vignettes

Concept Multiple Myeloma

Concept Plasma Cell Dyscrasia

Concept Recurrent Infection

Concept Renal Dysfunction

Concept Anemia

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Elyse Conley

Track Adult

Keywords

multiple myeloma

testosterone injection

cellulitis

acute kidney injury

monoclonal lambda light chains

protein electrophoresis

red marrow hyperplasia

PET-CT

myeloma cast nephropathy

plasmapheresis

Multiple Myeloma

Plasma Cell Dyscrasia

Recurrent Infection

Renal Dysfunction

Anemia