Abstract Body

Backgrounds and purpose:

Multiple myeloma, although a rare disease, is the second most common hematologic malignancy and represents 1% of all cancers. The average age of presentation is around 65 years, being exceptional in those under 30 years. Bone pain is the most frequent symptom on multiple myeloma, being the initial manifestation in 60-80% of cases, predominantly in the spine. It usually manifests as a mechanical pain, which respects the night's rest.

Case presentation

We describe the case of a 52-year-old male with no relevant medical history who presents to the emergency department complaining of nonradiating mechanical low back pain since two weeks, with good night rest and without improvement despite of the use of opioids. Physical examination was unremarkable except for tenderness of the lower lumbar vertebrae.

After x-ray evidence of vertebral fracture of L1 and L3 and, in the absence of medical history that could justify these findings, we decided to extend the study, finding severe bycitopenia and lytic lesions on vertebrae, ribs and sternum on CT scan. These results progressively guided to the final diagnosis of Multiple Myeloma.

Conclusion

In reference to this case, low back pain was the initial symptom and the reason for consultation, with the typical characteristics described above. Multiple Myeloma is also associated with a significant morbidity due to its end-organ destruction. Therefore, this pathology must be part of the differential diagnosis of lower back pain, always supported by an adequate clinical assessment.