Thanks to Grant for presenting the crazy case of a relatively well-appearing man who was found to have multi-organ dysfunction and was ultimately diagnosed with multiple myeloma!
Pearls on multiple organ dysfunction syndrome and presenting symptoms/signs of multiple myeloma are below:
Multiple organ dysfunction syndrome (MODS): progressive organ dysfunction in an acutely ill patient requiring intervention.
Can be primary or secondary, and due to infectious or non-infectious causes.
Primary MODS: Well-defined insult with early organ dysfunction attributable to the insult itself (e.g. renal failure from rhabdo)
Secondary MODS: Due to host’s response to insult (e.g. ARDS from pancreatitis)
– Any cause of shock including distributive, cardiogenic, hypovolemic/hemorrhagic, etc
– Severe non-infectious inflammatory states (e.g. pancreatitis)
– End-stage disease of a single organ (e.g. liver failure, bone marrow failure)
– MAHA (DIC, TTP/HUS)
– Autoimmune or thromboembolic disease (e.g. APLS)
– Severe disseminated malignancy, particularly tumor lysis syndrome
– Rare atypical infection (e.g. leptospirosis)
– Toxic shock
Clinical presentation of multiple myeloma:
Bone pain (58%)
Elevated creatinine (48%)
Weight loss (24%)