{"id":10715,"date":"2025-11-14T07:08:05","date_gmt":"2025-11-14T07:08:05","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=10715"},"modified":"2025-11-14T09:10:26","modified_gmt":"2025-11-14T09:10:26","slug":"atypical-presentation-of-multiple-myeloma-in-a-43-year-old-male-sudden-onset-body-ache-with-acute-kidney-injury-hypercalcemia-and-no-a-g-reversal","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-november-2025\/atypical-presentation-of-multiple-myeloma-in-a-43-year-old-male-sudden-onset-body-ache-with-acute-kidney-injury-hypercalcemia-and-no-a-g-reversal\/","title":{"rendered":"Atypical Presentation of Multiple Myeloma in a 43-Year-Old Male: Sudden-Onset Body Ache with Acute Kidney Injury, Hypercalcemia, and No A\/G Reversal"},"content":{"rendered":"

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Abstract<\/h2>\n

Background: Multiple myeloma (MM) is a plasma-cell malignancy characterized by anemia, bone pain, renal dysfunction, and hypercalcemia. It may rarely present acutely with nonspecific complaints such as body ache or vomiting.<\/p>\n

Case Presentation:<\/strong> A 43-year-old male presented with sudden-onset generalized body ache for 3 days and two episodes of vomiting for 1 day, associated with acute worsening of renal function. Laboratory evaluation showed severe anemia (hemoglobin 5.4 g\/dL), hypercalcemia (14.9 mg\/dL), and a rise in serum creatinine from 1.45 to 2.45 mg\/dL within 2 days. Total leukocyte count was 7,560\/mm\u00b3 and platelet count 236,000\/mm\u00b3. Serum total protein was 6.4 g\/dL with normal albumin and no albumin-to-globulin (A\/G) reversal. Parathyroid hormone (PTH) was suppressed (<4 pg\/mL), vitamin D was 22 ng\/mL, and ACE levels were normal. PET-CT revealed multiple lytic skeletal lesions. Findings were consistent with plasma-cell dyscrasia, likely multiple myeloma.<\/p>\n

Conclusion:<\/strong> This case demonstrates an acute and atypical presentation of multiple myeloma with body ache, vomiting, renal dysfunction, and hypercalcemia, but no A\/G reversal. MM should be considered even when classical biochemical features are absent.<\/p>\n

Introduction<\/h2>\n

Multiple myeloma (MM) is a malignant proliferation of plasma cells that accounts for approximately 10% of hematologic malignancies. The disease is characterized by CRAB features\u2014hyperCalcemia, Renal dysfunction, Anemia, and Bone lesions 1<\/sup>.<\/p>\n

While the presentation is typically gradual, some patients develop acute metabolic derangements leading to sudden symptoms such as bone pain, vomiting, and renal impairment. This case highlights a 43-year-old man presenting with 3 days of body ache and recent vomiting, who was subsequently found to have MM without the classical A\/G reversal.<\/p>\n

Case Presentation<\/h2>\n

A 43-year-old male presented with sudden-onset generalized body ache for 3 days and two episodes of vomiting for 1 day. The vomiting was non-bilious and non-bloody. He also complained of fatigue and malaise. There was no history of fever, weight loss, or chronic illness. He denied use of nephrotoxic medications and had no history of diabetes or hypertension.<\/p>\n

Clinical Examination<\/h2>\n

The patient was pale but hemodynamically stable. There was no lymphadenopathy or organomegaly. Diffuse bony tenderness was noted over the axial skeleton; neurological examination was normal.<\/p>\n

Investigations<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Parameter<\/strong><\/td>\nResult\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/td>\nReference Range<\/strong><\/td>\n<\/tr>\n
Hemoglobin<\/td>\n5.4 g\/dL<\/td>\n13\u201317 g\/dL<\/td>\n<\/tr>\n
Total Leukocyte Count<\/td>\n7,560 \/mm\u00b3<\/td>\n4,000\u201311,000 \/mm\u00b3<\/td>\n<\/tr>\n
Platelet Count<\/td>\n236,000 \/mm\u00b3<\/td>\n150,000\u2013450,000 \/mm\u00b3<\/td>\n<\/tr>\n
Serum Calcium<\/td>\n14.9 mg\/dL<\/td>\n8.5\u201310.5 mg\/dL<\/td>\n<\/tr>\n
Serum Creatinine<\/td>\n2.45 mg\/dL (\u2191 from 1.45 mg\/dL 2 days earlier)<\/td>\n0.6\u20131.2 mg\/dL<\/td>\n<\/tr>\n
PTH<\/td>\n<4 pg\/mL<\/td>\n15\u201365 pg\/mL<\/td>\n<\/tr>\n
25(OH) Vitamin D<\/td>\n22 ng\/mL<\/td>\n30\u2013100 ng\/mL<\/td>\n<\/tr>\n
ACE Level<\/td>\nNormal<\/td>\n\u2014————–<\/td>\n<\/tr>\n
Serum Total Protein<\/td>\n6.4 g\/dL<\/td>\n6.0\u20138.0 g\/dL<\/td>\n<\/tr>\n
Albumin-to-Globulin Ratio<\/td>\nNo A\/G reversal<\/td>\n—————–<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n