18. A Pain in the Bone

  1. James C. Pile3,
  2. Thomas E. Baudendistel4 and
  3. Brian J. Harte5
  1. John Fani Srour1,
  2. Julia Braza2 and
  3. Gerald W. Smetana1

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch18

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Srour, J. F., Braza, J. and Smetana, G. W. (2013) A Pain in the Bone, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch18

Editor Information

  1. 3

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 4

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 5

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

  2. 2

    Division of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • bone pain;
  • hypercalcemia;
  • lymphoproliferative disorders;
  • malignancy;
  • myeloma;
  • osteopenia;
  • primary bone lymphoma (PLB)

Summary

In the case study discussed in this chapter, symptomatic hypercalcemia, a history of transplantation, marked elevation of both lactate dehydrogenase (LDH) and beta-2 microglobulin (B2M), and a normal parathyroid hormone (PTH) level all pointed toward malignancy. In a patient with diffuse osteopenia and hypercalcemia, clinicians must consider multiple myeloma and other lymphoproliferative disorders; the absence of osteoblastic or osteolytic lesions and a normal alkaline phosphatase do not rule out these diagnoses. When the results of serum and urine protein electrophoresis (SPEP and UPEP, respectively) exclude multiple myeloma, the next investigation should be a bone biopsy to exclude primary bone lymphoma (PLB), an uncommon cause of anemia, hypercalcemia, and osteopenic, painful bones. While rare, PLB can be considered in patients with hypercalcemia and bone pain, along with the more common diagnoses of multiple myeloma and metastatic bone disease.