nikhilchadha Internal Medicine multiple lytic lesions in elderly female who presented with left hip pain and pathological fracture.. Found to have anemia and renal failure.. Bone marrow and serum immunofixation consistent with diagnosis of multiple myeloma .. Textbook ! --- ### Common presentation ### Why you should join Figure 1 - Share your knowledge with our global community of healthcare professionals - Get help from experts in your field - Learn from our library of real-world cases and quizzes ##### Similar cases \n\ A 62-year-old male presented with right shoulder pain following a skiing injury. Radiography revealed multiple osteolytic lesions, leading to a diagnosis of multiple myeloma. A skeletal survey confirmed widespread bone involvement. For symptom control, the patient’s left hip was irradiated, and he began monthly dexamethasone and bisphosphonate therapy. Bone marrow aspirates showed plasma cell infiltration decreased from 70% to 15%. He was started on thalidomide, declining chemotherapy and bone marrow transplant at that stage. He then presented with left rib pain; repeat marrow aspirate showed a dramatic increase to 90% plasma cells, consistent with refractory disease. The patient agreed to receive VAD (vincristine, adriamycin, dexamethasone) chemotherapy, which was initiated during this admission. For palliation of rib and spine lesions, further radiation was administered. Imaging revealed lumbar spine involvement with compression fractures. Outpatient plans included additional radiotherapy for spinal disease. At what point in this patient’s course would you have recommended autologous stem cell transplant, and why?](https://app.figure1.com/case-detail/46700d65-5b5d-4e60-a480-403791aa0df6) \n\ 24 yo male has HD with bone marrow infiltration\ the doctor recommed to receive DHAP ( cisplatin with high dose ara-c) his ANC =0.4 and Platelets= 44\ is this a correct decision ??](https://app.figure1.com/case-detail/472edb60-c621-4f1a-bbb6-e1c280a7c294) \ Autologous apheresis collection. Patient mobilized with Neupogen and Mozobil. These cells are being stored for a future autologous stem cell transplant. Second picture is CBC/diff at a 1:10 dilution. \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a) \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5) \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de) \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)