Li Xuanna, Li Shuang, Chen Junrong
Department of General Medicine Practice, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Front Med (Lausanne). 2025 Aug 18;12:1635403. doi: 10.3389/fmed.2025.1635403. eCollection 2025.
The high prevalence of fatigue as an atypical clinical manifestation in general practice creates notable diagnostic challenges, particularly in geriatric patients.
We describe a case of an 80-year-old female presenting with fatigue, initially attributed to poorly controlled diabetes mellitus or upper respiratory infection, who was ultimately diagnosed with multiple myeloma after admitted to the Department of General Medicine at a general hospital. Initial diagnostic workup including physical examination revealed the presence of anterior thoracic mass with undetermined etiology. Laboratory analysis demonstrated characteristic hematological abnormalities: normocytic anemia (hemoglobin 91 g/L), significant hyperglobulinemia (serum globulin 76.18 g/L), and hypoalbuminemia (serum albumin 27.94 g/L), showing a reversed albumin-globulin (A/G) ratio of 0.37. Guided by Murtagh's safe diagnostic strategy, comprehensive imaging studies including contrast-enhanced cervical, thoracoabdominal computed tomography (CT) and 18F-FDG PET-CT were performed. Histopathological confirmation was obtained from the gastric mass (CD138/CD38 plasma cell infiltration) and anterior mediastinal tumor ( light chain restriction). Serum immunofixation electrophoresis revealed monoclonal IgA- paraprotein, while bone marrow aspiration demonstrated 80% clonal plasma cells. These findings collectively fulfilled the International Myeloma Working Group (IMWG) diagnostic criteria for multiple myeloma with extramedullary involvement.
The patient was transferred to Hematology Department for further therapy. Clinical reassessment at 6-week follow-up showed symptomatic improvement and anterior thoracic mass regression.
We report a diagnostic case study of a MM patient whose initial presentation was fatigue, and clinicians should prioritize the overall condition, reduce diagnostic delays and improve therapeutic outcomes through early intervention strategies.
疲劳作为非典型临床表现，在全科医疗中普遍存在，给诊断带来显著挑战，尤其是在老年患者中。
我们描述了一例80岁女性患者，最初因疲劳就诊，最初归因于糖尿病控制不佳或上呼吸道感染，在综合医院普通内科住院后最终被诊断为多发性骨髓瘤。初步诊断检查包括体格检查，发现前胸有病因不明的肿块。实验室分析显示有特征性血液学异常：正细胞性贫血（血红蛋白91g/L）、显著高球蛋白血症（血清球蛋白76.18g/L）和低白蛋白血症（血清白蛋白27.94g/L），白蛋白/球蛋白（A/G）比值倒置为0.37。在Murtagh安全诊断策略的指导下，进行了包括增强颈部、胸腹计算机断层扫描（CT）和18F-FDG PET-CT在内的综合影像学检查。从胃部肿块（CD138/CD38浆细胞浸润）和前纵隔肿瘤（轻链限制）获得了组织病理学证实。血清免疫固定电泳显示单克隆IgA副蛋白，而骨髓穿刺显示80%的克隆性浆细胞。这些发现共同符合国际骨髓瘤工作组（IMWG）多发性骨髓瘤伴髓外受累的诊断标准。
患者转至血液科进行进一步治疗。6周随访时的临床重新评估显示症状改善，前胸肿块消退。
我们报告了一例以疲劳为首发表现的多发性骨髓瘤患者的诊断案例研究，临床医生应优先考虑整体病情，通过早期干预策略减少诊断延误并改善治疗效果。
