A 61-year-old man has had dull, constant back pain for 3 months. He recently developed a cough productive of yellowish sputum. On physical examination there are crackles at the right lung base. Laboratory studies show sodium 140 mmol/L, potassium 4.4 mmol/L, chloride 101 mmol/L, CO2 26 mmol/L, glucose 78 mg/dL, urea nitrogen 49 mg/dL, creatinine 5 mg/dL, total protein 8.3 g/dL, albumin 3.7 g/dL, alkaline phosphatase 176 U/L, AST 45 U/L, ALT 22 U/L, and total bilirubin 1.2 mg/dL. A sputum culture grows Streptococcus pneumoniae. This is an X ray of the patient...
multiple lytic lesions ( punched out ) and fractures in the lumbar spine X ray ( AP and lateral ) differentials - multiple myeloma - mets
The ans. is more towards multiple myeloma, because the sputum culture show Strep. pneumoniae a capsulated bacteria, normally antibodies produced would help phagocytose these organism. In multiple myeloma there is a monoclonal production of immunoglobulins, leading to the depressed production of other antibody (thus increase susceptibility to encapsulated organisms)
