Fever, Cough, Back Pain and Fatigue

Robert A. Kyle, MD, and Michael Tomasson, MD

Dr. Kyle: Mayo Clinic College of Medicine
Dr. Tomasson: Washington University School of Medicine, St. Louis, MO

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

This case was reviewed and updated in March 2011 by Dr. Shirley Parker Levine and members of the Teaching Cases Subcommittee.


Diagnosis: Multiple myeloma

Therapy for hematologic malignancies is constantly evolving. Each patient needs a careful diagnostic evaluation and therapy as part of a clinical trial or treatment that is selected specifically for that patient, based on the characteristics of his/her disease, stage, age, etc. There are currently several active chemotherapeutic agents, including melphalan, thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade), a first-in-class proteosome inhibitor. Initial treatment may also include autologous peripheral stem cell transplantation.

Clinical course: The patient was treated and showed improvement, but subsequently died of renal complications.

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