This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

Reference:


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.