Skill Checkup: An Elderly Man With Leg Pain and Weakness

Maria-Victoria Mateos, MD, PhD; Simon J. Harrison, MBBS, PhD

Disclosures

April 04, 2022

This patient has new-onset bone pain and increasing weakness, as well as a history of MM. The presence of high levels of monoclonal protein in his urine strongly suggests that his MM has relapsed and that he should undergo a complete workup, including repeat cytogenetic analysis and imaging evaluation to identify any new lytic lesions. The most common symptom associated with MM is bone pain; these individuals may also be more susceptible to fractures. Patients are also at a significantly increased risk of infection owing to myeloma-induced immunosuppression.

Prediabetes based on an elevated A1c is neither indicative of severe disease nor would it account for the patient's leg pain.

Normal aging and spinal stenosis are known to be accompanied by aches and pains, but the new onset and severity in this individual are much more suggestive of progressive MM than just the passage of years.

With imaging showing no signs of a new cerebrovascular event, secondary stroke is unlikely.

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