Question

A 70-year-old man comes to the physician because of fever, productive cough, and pleuritic chest pain for 1 day. Over the past 2 years, he has had two similar episodes. He also has had persistent pain in the thoracic spine for 1 month. His temperature is 39.2°C (102.6°F), pulse is 94/min, respirations are 22/min, and blood pressure is 110/60 mm Hg. There is dullness to percussion and decreased breath sounds over the right base. Examination shows tenderness of the midthoracic spine. Laboratory studies show:Hematocrit 34%Leukocyte count 15,000/mm3Neutrophils 81%Bands 4%Lymphocytes 15%Serum calcium 10.9 mg/dLX-rays of the chest show consolidation of the right lower lobe, lytic lesions at T8 and T10, and diffuse osteopenia. Which of the following is the most likely diagnosis of this patient's back condition?(A) HIV infection(B) Multiple myeloma(C) Prostate cancer(D) Staphylococcal osteomyelitis(E) Tuberculosis osteomyelitis

Answer 1

This patient has B.multiple myeloma.

Step-by-step explanation:

In multiple myeloma, the bone cells are responsible for destroying it because by means of chemical substances called cytokines the osteoclasts are going to be activated (they are responsible for destroying the bone) and they themselves will produce il6, a molecule responsible for increasing the cancer cells and osteoblasts (responsible for maintaining and producing normal bone matrix) will be inhibited. Through a non-physiological balance, for this reason the damage occurs. For this reason, bone mass will be lost and lytic lesions will appear.

In addition, in multiple myeloma there is a generalized loss of mineralized bone which will cause a condition called osteopenia. Also,This process can produce hypercalcemia as observed in the patient since the bone wear generates calcium release to the bloodstream.

Patients who have multiple myeloma are more likely to get infections. In addition, by contracting an infection, you may have a slow response to treatment. Pneumonia is a common and serious infection that occurs in these patients, as could probably be observed concomitantly in this patient.