A typical onset of multiple myeloma manifesting with persistent cytopenias and kidney dysfunction: a case report

Abstract

Multiple myeloma is a clonal plasma cell neoplasm capable of producing severe multisystem compromise, including progressive anemia, renal dysfunction and immune suppression. Its initial presentation is often subtle and nonspecific, delaying diagnosis and treatment. Early recognition is critical to prevent irreversible organ injury. We present the case of a 48-year-old woman with a history of chronic kidney disease who was admitted due to persistent constitutional symptoms, transfusion-dependent anemia, nausea, marked asthenia, weight loss of 8 kilograms and recurrent vomiting. Initial laboratory findings revealed severe cytopenias, elevated creatinine levels and persistent electrolyte imbalance. Autoimmune studies were negative. Serum free light chain testing demonstrated a marked elevation of kappa chains, and bone marrow immunohistochemistry showed strong CD138 positivity in approximately 80 percent of the marrow cellularity, consistent with plasma cell neoplastic infiltration. Flow cytometry confirmed the presence of a clonal plasma cell population compatible with plasma cell dyscrasia. She was diagnosed with active multiple myeloma with renal involvement and severe hematologic compromise, requiring repeated transfusion support and chemotherapy initiation. This case illustrates an atypical and rapidly progressive presentation of multiple myeloma in a relatively young patient, initially masked by chronic kidney disease and constitutional symptoms. Persistent cytopenias combined with renal impairment should prompt early investigation for plasma cell disorders, as timely diagnosis remains essential to reduce morbidity and improve prognosis.