Common in older adults - median age 60 years; M >F
Presenting clinical features include symptoms of:
- bone disease
- patients may initially present with unexplained backache or bone pain
- long bones, ribs, skull, and pelvis are also commonly involved
- may present as a pathologic fracture (26 to 34% of patients) following minimal trauma, especially of the femoral neck
- weakness and paresthesias in the lower extremities due to vertebral compression fractures
- carpal tunnel syndrome - the most common peripheral neuropathy associated with multiple myeloma
- anaemia
- fatigue and malaise
- recurrent or persistent bacterial infection
- due to suppression of antibody production and neutropenia
- commonly with encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae;
- hypercalcaemia
- nausea, fatigue, confusion, polyuria, constipation (1,2)
- renal failure
- occurs in 20 to 40% of patients
- due to direct tubular damage from excess protein load, dehydration, hypercalcemia, and the use of nephrotoxic medications (3)
- aggravated by hypercalcaemia
- weight loss
- occurs in less than one fourth of patients (1,2)
- hyperviscosity -
- mucosal bleeding, vertigo, nausea, visual disturbances, alterations in mental status
- hyperviscosity syndrome is more common in IgA than IgG disease
- fever (3)
It is important to remember that around 34% of patients are asymptomatic at presentation and are diagnosed following the incidental detection of a raised ESR, plasma viscosity, serum protein or globulin, creatinine, calcium, or hemoglobin laboratory panels (1)
On examination:
- bone tenderness may be present at the sites of growth
- occasionally soft tissue masses
- neuropathy related to tumourous infiltration of nerve root trunks - symmetric sensorimotor, gradual in onset, and progressive, with pain and dysesthesia (impairment of any sense, especially touch) in limbs; more common in men
- lymphadenopathy and splenomegaly are exceptional
- hepatomegaly is common
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