Complications in a Patient With Multiple Myeloma Mimicking Bronchopneumonia

TL;DR

A patient with multiple myeloma was initially misdiagnosed with pneumonia, highlighting the importance of considering underlying conditions in pulmonary complications.

Contribution

This case emphasizes the need to recognize multiple myeloma as a potential cause of respiratory distress and altered mental status.

Findings

The patient's respiratory distress was later attributed to multiple myeloma rather than pneumonia.

Hypercalcemia and lytic bone lesions were key indicators of multiple myeloma.

The patient's condition deteriorated despite treatment, leading to multi-organ dysfunction and death.

Abstract

An elderly gentleman with a history of ischemic heart disease was admitted with respiratory distress. On evaluation, he exhibited renal dysfunction and elevated levels of total protein and globulin. The following day, the patient developed altered sensorium; further evaluation identified hypercalcemia, leading to a provisional diagnosis of hypercalcemic encephalopathy. A non-contrast CT scan of the brain revealed multiple lytic lesions in the skull, which were suspected to be a forerunning indicator for a possible multiple myeloma (MM). Bone marrow studies and protein electrophoresis further confirmed the same. A diagnosis of MM in the garb of an unsuspecting pneumonia was evident. Our patient was promptly initiated on chemotherapy alongside supportive therapy. However, he succumbed to illness following prolonged ICU admission, complicated by acute respiratory distress syndrome and multi-organ dysfunction. Hence, this case served as a reminder to consider the various agencies of pulmonary worsening in a patient with MM.

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