MOFFITT AM REPORT PEARLS 7/11/16: Multiorgan Failure and Multiple Myeloma!

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)

Causes include:

– 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)

– Endocarditis

– Vasculitis


– Autoimmune or thromboembolic disease (e.g. APLS)

– Severe disseminated malignancy, particularly tumor lysis syndrome

– Rare atypical infection (e.g. leptospirosis)

– Toxic shock

– Trauma


Clinical presentation of multiple myeloma:


Anemia (73%)

Bone pain (58%)

Elevated creatinine (48%)

Fatigue/weakness (32%)

Hypercalcemia (28%)

Weight loss (24%)



Paresthesias (5%)

Hepatomegaly (4%)

Splenomegaly (1%)

Lymphadenopathy (1%)

Fever (0.7%)






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