{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T23:33:28Z","timestamp":1776382408075,"version":"3.51.2"},"reference-count":41,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,12,17]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Multiple myeloma is a rare haematologic malignancy, representing about 1\u20132% of all cancers and 17% of haematologic malignancies in the US, predominantly affecting older adults and more common in African Americans (AAs) and men. Light-chain multiple myeloma, a subtype accounting for 15% of multiple myeloma cases, often has a more aggressive clinical course. This case report discusses a rare case of an AA female in her early 30s, diagnosed with light-chain multiple myeloma following a pathological rib fracture. Initial symptoms were atypical, and diagnosis was delayed due to her young age and lack of common multiple myeloma signs, such as anaemia and hypercalcaemia. Treatment included induction chemotherapy and autologous stem cell transplant, leading to complete remission. This case underscores the need for heightened clinical suspicion and thorough investigation in young patients presenting with unexplained bone lesions, highlighting the diverse presentations and challenges in diagnosing multiple myeloma in younger populations.<\/jats:p>","DOI":"10.1136\/bcr-2024-262158","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T09:45:21Z","timestamp":1736243121000},"page":"e262158","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed diagnosis of multiple myeloma in a young patient: a call for vigilance in diagnosis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2379-9869","authenticated-orcid":false,"given":"Jigar","family":"Patel","sequence":"first","affiliation":[{"name":"Internal Medicine, The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seta","family":"Degann","sequence":"additional","affiliation":[{"name":"Internal Medicine, The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Ahmad","sequence":"additional","affiliation":[{"name":"The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Lesky","sequence":"additional","affiliation":[{"name":"Internal Medicine, The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"2025082709381637000_18.1.e262158.1","first-page":"373","article-title":"Multiple Myeloma: Diagnosis and Treatment","volume":"95","author":"Michels","year":"2017","journal-title":"Am Fam Physician"},{"key":"2025082709381637000_18.1.e262158.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21708"},{"key":"2025082709381637000_18.1.e262158.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-298760"},{"key":"2025082709381637000_18.1.e262158.4","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21718"},{"key":"2025082709381637000_18.1.e262158.5","doi-asserted-by":"publisher","DOI":"10.1023\/A:1022268103136"},{"key":"2025082709381637000_18.1.e262158.6","unstructured":"SEER cancer statistics. n.d. Available: https:\/\/seer.cancer.gov\/statfacts\/html\/mulmy.html"},{"key":"2025082709381637000_18.1.e262158.7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-12-194241"},{"key":"2025082709381637000_18.1.e262158.8","unstructured":"American Cancer Society . Cancer Facts & Figures 2024. Atlanta: American Cancer Society, 2024."},{"key":"2025082709381637000_18.1.e262158.9","unstructured":"National Cancer Institute . Cancer stat facts: myeloma. 2024. Available: https:\/\/seer.cancer.gov\/statfacts\/html\/mulmy.html"},{"key":"2025082709381637000_18.1.e262158.10","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1182\/blood.2021013539","article-title":"Diagnosed with myeloma before age 40","volume":"138","author":"Landgren","year":"2021","journal-title":"Blood"},{"key":"2025082709381637000_18.1.e262158.11","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25791"},{"key":"2025082709381637000_18.1.e262158.12","article-title":"An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring","volume":"10","author":"Rafae","year":"2018","journal-title":"Cureus"},{"key":"2025082709381637000_18.1.e262158.13","unstructured":"Rao M , Lamont JL , Chan J , et al . Serum free light chain analysis for the diagnosis, management, and prognosis of plasma cell dyscrasias. In: Comparative Effectiveness Review No. 73. Rockville, MD: Agency for Healthcare Research and Quality, 2012: 73."},{"key":"2025082709381637000_18.1.e262158.14","doi-asserted-by":"crossref","DOI":"10.1186\/1477-7819-12-234","article-title":"Light chain multiple myeloma, clinic features, responses to therapy and survival in a long-term study","volume":"12","author":"Zhang","year":"2014","journal-title":"World J Surg Oncol"},{"key":"2025082709381637000_18.1.e262158.15","doi-asserted-by":"publisher","DOI":"10.4065\/78.1.21"},{"key":"2025082709381637000_18.1.e262158.16","doi-asserted-by":"crossref","first-page":"5214","DOI":"10.3390\/curroncol30060396","article-title":"Young Myeloma Patients: A Systematic Review of Manifestations and Outcomes","volume":"30","author":"Tanguay","year":"2023","journal-title":"Curr Oncol"},{"key":"2025082709381637000_18.1.e262158.17","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s00277-014-2264-0","article-title":"Elderly multiple myeloma patients experience less deterioration in health-related quality of life than younger patients compared to a normative population: a study from the population-based PROFILES registry","volume":"94","author":"van der Poel","year":"2015","journal-title":"Ann Hematol"},{"key":"2025082709381637000_18.1.e262158.18","first-page":"192","article-title":"Metastatic bone tumors of the pelvis and lower extremity","volume":"12","author":"Buggay","year":"2003","journal-title":"J Surg Orthop Adv"},{"key":"2025082709381637000_18.1.e262158.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0193661","article-title":"Prevalence and risk of skeletal complications and use of radiation therapy in elderly women diagnosed with metastatic breast cancer","volume":"13","author":"Hussain","year":"2018","journal-title":"PLoS One"},{"key":"2025082709381637000_18.1.e262158.20","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/5971615","article-title":"Incidence of Skeletal-Related Events in Patients with Castration-Resistant Prostate Cancer: An Observational Retrospective Cohort Study in the US","volume":"2019","author":"Kawai","year":"2019","journal-title":"Prostate Cancer"},{"key":"2025082709381637000_18.1.e262158.21","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1097\/COC.0000000000000737","article-title":"Nationwide Patterns of Pathologic Fractures Among Patients Hospitalized With Bone Metastases","volume":"43","author":"Jairam","year":"2020","journal-title":"Am J Clin Oncol"},{"key":"2025082709381637000_18.1.e262158.22","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.041131"},{"key":"2025082709381637000_18.1.e262158.23","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s40620-018-0492-4","article-title":"Myeloma light chain cast nephropathy, a review","volume":"32","author":"Sathick","year":"2019","journal-title":"J Nephrol"},{"key":"2025082709381637000_18.1.e262158.24","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2007-03-081018"},{"key":"2025082709381637000_18.1.e262158.25","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1182\/blood.2021011285","article-title":"Epidemiological landscape of young patients with multiple myeloma diagnosed before 40 years of age: the French experience","volume":"138","author":"Caulier","year":"2021","journal-title":"Blood"},{"key":"2025082709381637000_18.1.e262158.26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611750"},{"key":"2025082709381637000_18.1.e262158.27","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1182\/blood.2019000241","article-title":"Bortezomib, lenalidomide, and dexamethasone as induction therapy prior to autologous transplant in multiple myeloma","volume":"134","author":"Rosi\u00f1ol","year":"2019","journal-title":"Blood"},{"key":"2025082709381637000_18.1.e262158.28","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.8164"},{"key":"2025082709381637000_18.1.e262158.29","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-02-268862"},{"key":"2025082709381637000_18.1.e262158.30","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31240-1"},{"key":"2025082709381637000_18.1.e262158.31","doi-asserted-by":"crossref","DOI":"10.1182\/blood-2019-123465","article-title":"Depth of Response to Daratumumab (DARA), Lenalidomide, Bortezomib, and Dexamethasone (RVd) Improves over Time in Patients (pts) with Transplant-Eligible Newly Diagnosed Multiple Myeloma (NDMM): Griffin Study Update","volume":"134","author":"Voorhees","year":"2019","journal-title":"Blood"},{"key":"2025082709381637000_18.1.e262158.32","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1001\/jamaoncol.2021.0611","article-title":"Safety and Effectiveness of Weekly Carfilzomib, Lenalidomide, Dexamethasone, and Daratumumab Combination Therapy for Patients With Newly Diagnosed Multiple Myeloma: The MANHATTAN Nonrandomized Clinical Trial","volume":"7","author":"Landgren","year":"2021","journal-title":"JAMA Oncol"},{"key":"2025082709381637000_18.1.e262158.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32556-5"},{"key":"2025082709381637000_18.1.e262158.34","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2019-02-895193"},{"key":"2025082709381637000_18.1.e262158.35","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805762"},{"key":"2025082709381637000_18.1.e262158.36","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1038\/s41375-020-0834-9","article-title":"Phase 1 study of the anti-BCMA antibody-drug conjugate AMG 224 in patients with relapsed\/refractory multiple myeloma","volume":"35","author":"Lee","year":"2021","journal-title":"Leukemia"},{"key":"2025082709381637000_18.1.e262158.37","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-18-2752"},{"key":"2025082709381637000_18.1.e262158.38","doi-asserted-by":"crossref","DOI":"10.1038\/s41408-020-00350-x","article-title":"Immune-based therapies in the management of multiple myeloma","volume":"10","author":"Zanwar","year":"2020","journal-title":"Blood Cancer J"},{"key":"2025082709381637000_18.1.e262158.39","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMct0805626"},{"key":"2025082709381637000_18.1.e262158.40","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13040863","article-title":"Role of Stem Cell Transplantation in Multiple Myeloma","volume":"13","author":"Devarakonda","year":"2021","journal-title":"Cancers (Basel)"},{"key":"2025082709381637000_18.1.e262158.41","doi-asserted-by":"crossref","DOI":"10.1182\/blood-2021-150848","article-title":"An in Depth Analysis of Factors Contributing to Diagnostic Delay in Myeloma: A Retrospective UK Study of Patients Journey from Primary Care to Specialist Secondary Care","volume":"138","author":"Hossain","year":"2021","journal-title":"Blood"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-262158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:38:30Z","timestamp":1756312710000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-262158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,7]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bcr-2024-262158"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-262158","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}