Severe anemia and renal impairment: A case report on multiple myeloma

A 51-year-old female patient presented to the emergency department with severe body aches, generalized weakness, decreased appetite, recurrent fever, weight loss, cough with sputum, and shortness of breath for one week. The patient had a history of closed reduction and internal fixation (CRIF) of the right femur two months ago. Physical examination revealed pallor, bilateral air entry positive in the lungs, and normal heart sounds. Laboratory investigations showed severe anemia (hemoglobin 7.1 g/dL), leukocytosis (WBC 20.3 x10³/µL), thrombocytosis, elevated serum creatinine (2.11 mg/dL), mild hypoalbuminemia (2.5 g/dL), hypokalemia (2.3 mEq/L), proteinuria, and elevated serum calcium (11.2 mg/dL). Bence-Jones protein was positive, and beta-2 microglobulin was elevated at 4.0 mg/L. X-ray and MRI findings revealed multiple lytic lesions and vertebral compression fractures, suggesting skeletal involvement. CT scans confirmed rib fractures and vertebral collapse due to osteolytic activity. 

Bone marrow biopsy showed hypercellular marrow with 30% plasma cells, predominantly immature and plasmablastic forms, expressing monoclonal kappa light chains. Flow cytometry confirmed the clonal nature of plasma cells, diagnosing multiple myeloma. The patient’s clinical presentation and diagnostic findings were consistent with a diagnosis of multiple myeloma, characterized by anemia, renal dysfunction, hypercalcemia, lytic bone lesions, and monoclonal plasma cells.