Multiple myeloma presenting with an acute bacterial infection
G N Kalambokis1, L Christou, E V Tsianos
11st Division of Internal Medicine, University Hospital, Ioannina, Greece.
International Journal of Laboratory Hematology
|June 3, 2009
Summary
Acute bacterial infections can be the first sign of multiple myeloma (MM) in asymptomatic individuals. Musculoskeletal infections, particularly septic arthritis, were common in these early MM cases.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Multiple myeloma (MM) commonly causes increased susceptibility to bacterial infections due to impaired humoral immunity.
- Infections are more frequent early after diagnosis and in patients with renal dysfunction.
- While common, acute bacterial infections are rarely the initial presentation of underlying MM.
Purpose of the Study:
- To review cases where acute bacterial infection was the first manifestation of multiple myeloma.
- To analyze the characteristics and outcomes of these early presentations.
Main Methods:
- Systematic review of 17 reported cases of MM presenting initially with acute bacterial infection.
- Data analyzed spanned from 1978 to 2008.
- Focus on patient demographics, infection types, causative agents, and clinical findings.
Main Results:
- Median patient age was 65.5 years, with a predominance of females.
- Musculoskeletal infections (47%), especially septic arthritis (35%), were the most common initial presentation.
- Streptococcus pneumoniae was the predominant pathogen (two-thirds of cases), with bacteremia in 80%; renal impairment occurred in 67%.
Conclusions:
- Multiple myeloma should be suspected in middle-aged, previously asymptomatic patients presenting with severe bacterial infections.
- Septic arthritis and pneumococcal bacteremia warrant particular suspicion for underlying MM.
- Early presentations often involve immunodeficiency due to decreased polyclonal immunoglobulins.
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