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Infection--an underappreciated cause of bone pain in multiple myeloma
Raman Desikan1, Bart Barlogie, Rajesh Sethi
1Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Abstract:
Bone pain, especially back pain, is a common presenting feature of myeloma patients. We report three multiple myeloma patients with exacerbations of back pain and referred shoulder pain resulting from vertebral infections. Two patients were treated with surgery, and one patient had computerized tomography-guided percutaneous needle aspiration for diagnostic purposes. All three patients received a prolonged course of antibiotics. Vertebral infection resolved with this treatment in all three patients without any recurrence. Previous dexamethasone therapy, together with an episode of bacteraemia, appears to be a predisposing factor for vertebral infection. Magnetic resonance imaging enabled the diagnosis in all three patients.
Insights
Multiple myeloma patients experiencing back pain may have vertebral infections. Prompt diagnosis with MRI and treatment with antibiotics and surgery can resolve these infections, preventing recurrence.
Area of Science:
- Oncology
- Infectious Diseases
- Radiology
Background:
- Bone pain, particularly back pain, is a frequent symptom in multiple myeloma patients.
- Vertebral infections can exacerbate existing pain and cause referred pain in myeloma patients.
Observation:
- Three multiple myeloma patients presented with worsening back and referred shoulder pain due to vertebral infections.
- Diagnosis was achieved using Magnetic Resonance Imaging (MRI).
- Predisposing factors included prior dexamethasone therapy and bacteraemia.
Findings:
- Two patients underwent surgical intervention for vertebral infection.
- One patient had a diagnostic computerized tomography-guided percutaneous needle aspiration.
- All patients received prolonged antibiotic therapy, leading to complete resolution of infection without recurrence.
Implications:
- Vertebral infections are a significant complication in multiple myeloma patients.
- Early diagnosis via MRI and appropriate treatment are crucial for successful management.
- Identifying predisposing factors can aid in preventative strategies for myeloma patients.