LOW BACK PAIN AS FIRST MANIFESTATION OF MULTIPLE MYELOMA – A CASE REPORT

Introduction and Objective: A 65-year-old caucasian female presents with intermittent low back pain for four months that is resistant to several analgesic drugs prescribed. She also had progressive weakness and anorexia and lost 7 Kg in 4 months. Blood tests requested by her family doctor revealed anemia, with no iron deficiency, and lumbar x-ray revealed lytic lesions. She was referred to the Hospital Emergency Unit, since she had progressive disability, for further investigation. The patient was hospitalized and diagnosed with multiple myeloma, with a concordant serum protein electrophoresis and a myelogram. The aim of this work is to describe this clinical case and to highlight this kind of presentation of multiple myeloma. Methods: Review of the clinical process and of recent literature associated with suspicion and diagnose of multiple myeloma. Results and Conclusions: Multiple myeloma is the most common bone malignancy and it occurs with increased frequency in older persons. Bone pain, particularly low back pain, is a typical symptom, such as anemia, renal insufficiency, and hypercalcemia. However, it can also be an incidental discovery on blood analysis with serum protein electrophoresis. A patient with back pain and fatigue, for more than two to four weeks, and resistance to symptomatic treatment, should undergo further evaluation, and multiple myeloma should be a differencial diagnosis for family doctors. A complete blood count, erythrocyte sedimentation rate, chemistry panel, serum and urine protein electrophoresis, radiography, and vitamin D levels can assist in the differential diagnosis.