Zomorodian Alireza, Maalouf Naim M
Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
JCEM Case Rep. 2024 Jul 24;2(7):luae137. doi: 10.1210/jcemcr/luae137. eCollection 2024 Jul.
Multiple myeloma commonly manifests with symptoms arising from the involvement of various organs, particularly the bone and kidneys. In this report, we detail the case of a 44-year-old man who was diagnosed with multiple myeloma associated with reduced bone density. He exhibited clinical findings of osteomalacia due to Fanconi syndrome (characterized clinically by bone pain and proximal weakness and biochemically by elevated serum alkaline phosphatase, hypophosphatemia, hypouricemia, and glucosuria). With phosphate replacement, there was a notable improvement in bone pain, osteomalacia, and bone mineral density. Nevertheless, the patient continued to experience renal wasting of phosphate, uric acid, and glucose despite achieving remission from multiple myeloma for nearly 2 years. Our case highlights several important clinical features of myeloma-associated Fanconi syndrome, including the need to recognize this complication to appropriately treat the underlying bone disease while avoiding osteoclast inhibitors and the long-term persistence of the proximal renal tubulopathy despite achieving remission from myeloma and correction of osteomalacia.
多发性骨髓瘤通常表现为因累及多个器官，尤其是骨骼和肾脏而产生的症状。在本报告中，我们详细介绍了一名44岁男性患者的病例，该患者被诊断为与骨密度降低相关的多发性骨髓瘤。他表现出因范科尼综合征导致的骨软化临床症状（临床特征为骨痛和近端肌无力，生化特征为血清碱性磷酸酶升高、低磷血症、低尿酸血症和糖尿）。通过补充磷酸盐，骨痛、骨软化和骨矿物质密度有了显著改善。然而，尽管该患者多发性骨髓瘤已缓解近2年，但仍持续存在肾脏磷酸盐、尿酸和葡萄糖的流失。我们的病例突出了骨髓瘤相关范科尼综合征的几个重要临床特征，包括需要认识到这一并发症，以便在避免使用破骨细胞抑制剂的同时适当治疗潜在的骨病，以及尽管骨髓瘤已缓解且骨软化已得到纠正，但近端肾小管病变仍长期存在。
