Diagnostic Dilemma| Volume 134, ISSUE 7, P860-862, July 2021

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A 77-Year-Old Man with Multiple Myeloma and a Lytic Bone Lesion

  • Joseph Sassine
    Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston
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  • Dimitrios P. Kontoyiannis
    Requests for reprints should be addressed to Dimitrios P. Kontoyiannis, MD, ScD, PhD (Hon), FACP, FIDSA, FECMM, FAAM, FAAAS, Robert C. Hickey Chair in Clinical Care, Deputy Head, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030.
    Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston
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Published:February 20, 2021DOI:
      A 77-year-old patient with multiple myeloma and on lenalidomide developed a slowly progressive right upper thigh pain with no antecedent trauma. The status of his multiple myeloma was stable, and he did not have a history of osteolytic lesions. He had not received corticosteroids as part of his multiple myeloma therapy. He was found to have a right proximal femur lytic lesion (Figure 1) and received local radiation therapy for 2 months; however, the lytic lesion increased in size, associated with worsening pain and affecting his mobility and ability to carry his daily activities. Positron emission tomography-computed tomography (PET-CT) showed a right proximal femoral diaphysis lesion with cortical destruction and intensely avid fluorodeoxyglucose (FDG) uptake. He presented for an elective intramedullary nail insertion to prevent a pathological fracture. He used to work in construction for more than 50 years and had spent most of his life in Kentucky. He is currently retired in Florida and plays golf in his spare time. His vital signs were normal, and his physical examination and baseline preoperative labs were unremarkable.
      Figure 1
      Figure 1Right femoral radiograph.
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