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[Multiple myeloma as an occupational disease after long-term benzene exposure in a distillery - a case report]
Ludwig Frei-Stuber1,2, Dennis Nowak1,2
1Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Comprehensive Cancer Center (CCC), Comprehensive Allergy Center, LMU Klinikum, LMU Medizin, Ludwig-Maximilians-Universität (LMU) München, Deutschland, München.
Anamnesis:
An 82-/84-year-old male patient (age difference due to 2 different expert assessments) presented with a 20 kg weight loss over 3 months. He had worked for several decades in the brewing industry, mainly in a distillery, with benzene exposure.
Investigations:
Laboratory findings showed moderate hematologic changes, elevated free IgG-kappa light chains in serum and urine, with an increased kappa-/lambda-ratio and elevated β2-microglobulin. CT revealed a markedly heterogeneous bone matrix without clear focal osteo lesions.
Diagnosis:
Multiple myeloma stage II (R-ISS) with 13q-deletion.
Therapy And Course:
To improve bone density, vitamin D₃ and calcium were given orally and zoledronic acid intravenously. Multiple myeloma was recognized as occupational disease No. 1318 according to Appendix 1 of the Occupational Diseases Ordinance in Germany.
Conclusions:
Physicians should take an occupational history, and, if suspicion arises, are legally obliged to report any suspected case of occupational disease. Due to a lack of consideration, a high number of unreported cases and the loss of insurance benefits (statutory accident insurance) are possible. Adequate workplace safety can help prevent hematologic malignancies and their consequences (including the economic burden).