Complications in a Patient With Multiple Myeloma Mimicking Bronchopneumonia

An elderly gentleman with a history of ischemic heart disease was admitted with respiratory distress. On evaluation, he exhibited renal dysfunction and elevated levels of total protein and globulin. The following day, the patient developed altered sensorium; further evaluation identified hypercalcemia, leading to a provisional diagnosis of hypercalcemic encephalopathy. A non-contrast CT scan of the brain revealed multiple lytic lesions in the skull, which were suspected to be a forerunning indicator for a possible multiple myeloma (MM). Bone marrow studies and protein electrophoresis further confirmed the same. A diagnosis of MM in the garb of an unsuspecting pneumonia was evident. Our patient was promptly initiated on chemotherapy alongside supportive therapy. However, he succumbed to illness following prolonged ICU admission, complicated by acute respiratory distress syndrome and multi-organ dysfunction. Hence, this case served as a reminder to consider the various agencies of pulmonary worsening in a patient with MM.