Clinical scenario: A 65-year-old lady presented with complaints of generalized body aches, arthralgia, loss of appetite and weight of 2 years duration.On examination, she was found to have pallor, severe malnutrition with BMI of 14kg/m2 , tenderness present over thoracic and lumbar vertebrae.

Investigations :Labs : anemia hb 4.5 with mcv 102.7 ,mch 30.8Esr 30, Platelet 45000 creatinine 2.2 with globulin 11.2 g/dl, albumin 2.6 .Corrected ca 10.In view of hypergammaglobulinemia, anemia, and renal dysfunction, there was a suspicion of multiple myeloma.X-ray skull and vertebrae were taken which showed punched out lesions in the skull and lytic lesions in vertebrae with fishbone appearance. Fig 1 and Fig2 Bone marrow aspiration showed plasma cells >50% of the marrow s/o multiple myelomaRenal dysfunction improved with adequate hydration and correction of anemia was done via blood transfusions.She is planned for chemotherapy . 

Fig 2 Lytic lesions in Vertebra fish bone appearance

Click to read Further Multiple myeloma 

This case was contributed by 

Dr. Rohit Rajeevan 
Assistant Professor 
Dept.of Medicine 
Yenepoya Medical College Hospital 
Mangalore Karnataka