Abdullah Hafez Mohammad Ammar, Ellithi Moataz, Waqas Qazi, Cunningham Arwyn, Oliver Tony
Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.
Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.
BMJ Case Rep. 2019 Aug 4;12(8):e229070. doi: 10.1136/bcr-2018-229070.
Hypercalcaemia, renal dysfunction, anaemia and bone lesions (CRAB) are a constellation of signs and symptoms that are collectively referred to as the CRAB features. When present together, multiple myeloma (MM) should be at the top of the differential diagnosis. We present a 69-year-old man who presented with severe body aches and bone pain in his ribs and pelvis, associated with fatigue and constipation. He was found to have hypercalcaemia, acute kidney injury, anaemia and numerous lytic lesion on chest imaging. Physical examination and imaging were unremarkable for any enlarged lymph nodes. The patient was initially suspected to have multiple myeloma, however, serum and urine protein electrophoresis, and serum free light chain assays were negative. The patient was ultimately diagnosed with diffuse large B cell lymphoma based on a bone marrow biopsy. This case highlights the fact that presence of hypercalcaemia, renal dysfunction, anaemia and bone lesions are not usually specific for MM.
高钙血症、肾功能不全、贫血和骨病变（CRAB）是一组体征和症状，统称为CRAB特征。当这些症状同时出现时，多发性骨髓瘤（MM）应列为鉴别诊断的首要考虑。我们报告一名69岁男性，他出现严重的全身疼痛以及肋骨和骨盆部位的骨痛，并伴有疲劳和便秘。他被发现有高钙血症、急性肾损伤、贫血，胸部影像学检查显示有多处溶骨性病变。体格检查和影像学检查未发现任何肿大淋巴结。该患者最初被怀疑患有多发性骨髓瘤，然而，血清和尿蛋白电泳以及血清游离轻链检测均为阴性。最终，根据骨髓活检，该患者被诊断为弥漫性大B细胞淋巴瘤。这个病例突出了一个事实，即高钙血症、肾功能不全、贫血和骨病变通常并非MM所特有。
