clinical features

Last reviewed 12/2021

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