{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:10:07Z","timestamp":1756372207820,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,1,22]]},"abstract":"<jats:p>Multiple myeloma is characterised by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow, resulting in extensive skeletal destruction with osteolytic lesions, osteopenia and pathological fractures. Additional disease-related complications include hypercalcaemia, renal insufficiency, anaemia and infection. We present the case of a 64-year-old woman presenting with rapid onset, painful distal symmetrical lower limb weakness and an acute kidney injury. Owing to her IgG \u03ba paraprotein (kappa light chain 4620, kappa:lambda ratio 826), she was diagnosed with probable plasma cell myeloma. This diagnosis was confirmed following a trephine biopsy. She required renal replacement therapy, inotropic support and a percutaneous tracheostomy. She became acutely confused with a Glasgow Coma Scale score of 10\/15 and a CT head showed no acute pathology. Further investigation with a lumbar puncture confirmed the diagnosis of streptococcal meningitis. She was treated with intravenous acyclovir, ceftriaxone and fluconazole. Her non-bronchoalveolar lavage revealed a diagnosis of <jats:italic>Pneumocystis carinii<\/jats:italic> pneumonia and she required treatment with co-trimoxazole. This case report discusses the clinical presentation, diagnostic algorithm and treatment of myeloma. This manuscript offers an important clinical reminder to consider myeloma in the differential diagnosis in patients presenting with bone pain and acute kidney injury.<\/jats:p>","DOI":"10.1136\/bcr-2016-217289","type":"journal-article","created":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T10:40:18Z","timestamp":1486464018000},"page":"bcr2016217289","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and <i>Pneumocystis carinii<\/i> pneumonia"],"prefix":"10.1136","volume":"2017","author":[{"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeraj","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Keating","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,2,7]]},"reference":[{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1177\/095952874402700129","article-title":"Remarks on the pathology of mollities ossium with cases","volume":"27","author":"Solly","year":"1844","journal-title":"Med Chir Trans Lond"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra041875"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.3","unstructured":"NICE Guidelines NG35. Myeloma: diagnosis and management. Published 10 February 2016. nice.org.uk\/guidance\/ng35 ."},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.4","doi-asserted-by":"crossref","first-page":"1460","DOI":"10.1093\/jnci\/djv342","article-title":"Maintenance therapy with immunomodulatory drugs in multiple myeloma: a meta-analysis and systematic review","volume":"108","author":"Wang","year":"2016","journal-title":"J Natl Cancer Inst"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2005.05867.x"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.6","first-page":"6848902","article-title":"Efficacy and safety of novel agent-based therapies for multiple myeloma: a meta-analysis","volume":"2016","author":"Wang","year":"2016","journal-title":"Biomed Res Int"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.7","first-page":"12202","article-title":"Single agent bortezomib or bortezomib-based regimens as consolidation therapy after autologous hematopoietic stem cell transplantation in multiple myeloma: a meta-analysis of randomized-controlled trials","volume":"8","author":"Gao","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.8","doi-asserted-by":"crossref","first-page":"320","DOI":"10.4103\/0366-6999.174497","article-title":"Thalidomide-based regimens for elderly and\/or transplant ineligible patients with multiple myeloma: a meta-analysis","volume":"129","author":"Lyu","year":"2016","journal-title":"Chin Med J"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.9","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00228-015-1998-5","article-title":"First-line therapy for non-transplant eligible patients with multiple myeloma: direct and adjusted indirect comparison of treatment regimens on the existing market in Germany","volume":"72","author":"Kuhr","year":"2016","journal-title":"Eur J Clin Pharmacol"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.10","first-page":"6743","article-title":"A meta-analysis of the anti-tumour effect and safety of bisphosphonates in the treatment of multiple myeloma","volume":"8","author":"Wang","year":"2015","journal-title":"Int J Clin Exp Med"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-007258"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.12","doi-asserted-by":"publisher","DOI":"10.5414\/CP202245"},{"key":"2025082801552269000_2017.feb06_2.bcr2016217289.13","first-page":"4051","article-title":"Prognostic value and efficacy evaluation of novel drugs for cytogenetic aberrations in multiple myeloma: a meta-analysis","volume":"7","author":"Yu","year":"2014","journal-title":"Int J Clin Exp Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-217289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:55:31Z","timestamp":1756371331000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-217289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2,7]]},"references-count":13,"alternative-id":["10.1136\/bcr-2016-217289"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-217289","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2017,2,7]]}}}