Kaufman Rod
Southern California University of Health Sciences, Whittier, CA, USA.
J Manipulative Physiol Ther. 2007 Sep;30(7):543-9. doi: 10.1016/j.jmpt.2007.07.002.
This case study describes a patient diagnosed with early manifestations of multiple myeloma and illustrates relevant aspects of differential diagnosis and the use of laboratory, radiologic, and advanced imaging techniques to aid in establishing the diagnosis and issues of management.
A 36-year-old male student experienced midback pain that occurred primarily at night in conjunction with fever and unexplained weight loss. Minor trauma induced a significant fracture and an occult fracture in the upper extremity. Physical examination revealed an elevated temperature indicating a fever of undetermined etiology. Plain radiographs revealed diffuse osteoporosis of the thoracic spine. Laboratory tests revealed anemia, hypercalcemia, and abnormal monoclonal paraprotein. Magnetic resonance imaging revealed a fracture with poor healing and an occult fracture in the upper extremity.
The patient was initially assessed for fever of undetermined etiology in association with nocturnal midback pain. Although considered a disease of the geriatric population, subsequent laboratory and radiologic evaluations established a diagnosis of early-onset multiple myeloma. Early recognition and referral with comanagement by an oncologist provided optimum care. Early-onset cases of multiple myeloma tend to have a more favorable response to treatment as compared with cases diagnosed in the geriatric population.
Multiple myeloma should be a consideration when a patient presents with nocturnal back pain and fever of undetermined etiology. Differentiating multiple myeloma from other causes of back pain is especially important in making management decisions. With a precise history and physical diagnosis, the diagnosis may be suspected, but confirmation must rely on ancillary investigations. Multiple myeloma is frequently accompanied by a poor prognosis, but early-onset cases generally respond more favorably to interventions.
本病例研究描述了一名被诊断为多发性骨髓瘤早期表现的患者，并阐述了鉴别诊断的相关方面以及实验室、放射学和先进成像技术在辅助诊断及管理问题中的应用。
一名36岁男性学生出现主要在夜间发作的中背部疼痛，伴有发热和不明原因的体重减轻。轻微外伤导致上肢出现明显骨折和隐匿性骨折。体格检查发现体温升高，提示病因不明的发热。X线平片显示胸椎弥漫性骨质疏松。实验室检查显示贫血、高钙血症和异常单克隆副蛋白。磁共振成像显示骨折愈合不良以及上肢隐匿性骨折。
患者最初因夜间中背部疼痛伴病因不明的发热接受评估。尽管多发性骨髓瘤被认为是老年人群的疾病，但随后的实验室和放射学评估确诊为早发性多发性骨髓瘤。早期识别并转诊，由肿瘤学家共同管理，提供了最佳治疗。与老年人群中诊断出的病例相比，早发性多发性骨髓瘤病例对治疗的反应往往更好。
当患者出现夜间背痛和病因不明的发热时，应考虑多发性骨髓瘤。在做出管理决策时，将多发性骨髓瘤与其他背痛原因区分开来尤为重要。凭借精确的病史和体格诊断，可能怀疑有该诊断，但确诊必须依靠辅助检查。多发性骨髓瘤通常预后不良，但早发性病例一般对干预反应更佳。
