Copyright (c) 2026 Celso J. Morales, Emanuel E. Atencio Z., Moisés A. Delvalle a:
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Multiple myeloma (MM) is a hematologic neoplasm characterized by the clonal proliferation of plasma cells, with classic manifestations summarized by the acronym CRAB: hypercalcemia, renal failure,
anemia, and lytic bone lesions. In some cases, the diagnosis is made incidentally while investigating other reasons for the patient’s visit.
Objective To present a case of multiple myeloma diagnosed incidentally in a patient who presented with back pain following a fall.
Method Clinical case report of a 67-year-old man with no relevant medical history who presented to Anita Moreno Hospital after falling approximately 5 meters with pain in his right back. X-rays and initial tests revealed severe renal failure and anemia. Due to the absence of immunological testing and the lack of a nephrology department, he was transferred to Gustavo Nelson Collado Hospital and subsequently to a referral center in Panama City.
Results The patient presented with generalized edema, severe anemia (Hb 7.5 g/dl), acute renal failure (creatinine 15.2 mg/dl, BUN 101 mg/dl), and multiple lytic bone lesions in the spine and skull. Immunological testing revealed elevated ?2-microglobulin (35.19 mg/L) and free kappa light chains at 16,382 mg/L, with a kappa/lambda ratio >1,000. Renal ultrasound showed enlarged, hyperechoic kidneys, consistent with myeloma nephropathy. The patient was diagnosed with multiple myeloma with acute renal failure, requiring urgent hemodialysis.
Conclusion. This case highlights the importance of suspecting multiple myeloma (MM) in older patients with new-onset renal failure, anemia, and bone lesions, and underscores the need for timely access to diagnostic testing and multidisciplinary management.
