Question

35 year old white male presents to the ER with low back pain for two weeks with increasing severity. He had a normal Lumbar spine X-ray and had a normal CBC and blood chemistry. A urinalyisis was done to look for signs of nephorlithiasis and showed no white cells or red blood cells but large protein and no bacteria. He had a slight fever and was in such pain that IV morphine did not even touch it. Examination was difficult as he could not even get into a comfortable position to lessen his pain. Internet searches on the local state pain medication abuse systems did not show him to be drug seeking but the ER doctor considers him drug seeking and wants him out of his ER. You are called as the nurse practitioner helping the nighttime hospitalist admit new patients to the hospital and you are paged to consult as your physician is busy with another admission on the floor with an MI. You question this young man and find him to be in terrible pain and barely able to answer your questions, he looks well-developed and well-nourished and yells when you palpate around L3 and L4 lumbars. You decide to admit him to the hospital as you have no other choice and decide to do a urine protein analysis after seeing the urinalysis. The analysis comes in with high levels of M-proteins and you also ordered an MRI of his lumbar spine and find that he has lytic lesions through out the lumbar spine in the early stages. What is your diagnosis? What is his treatment? Are you glad you admitted this patient and did not send him home as the ER doctor wanted? What is his overall prognosis? Use what you have read to answer these questions

Answer 1

The diagnosis is multiple myeloma . its a cancer of the plasma cells which is a form of white blood cells .

Treatment is in the form of chrmotherapy, radiotherapy , stem cell transplant and medicines like busphosphonates which help in reducing bone loss.

Yes i am glad we kept the patient and came at a diagnosis.

the patient already has symptoms and high level of proteins with lesions in the bone . This suggest advanced stage so life expectancy is around 29 months for this stage but with treatment and if he manages to have a succesful stem cell transplant the survival can be extended . It is a disease with waxing and waning of symptoms .