CASE REPORT article
Front. Med.
Sec. Family Medicine and Primary Care
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1635403
Fatigue as main symptom in an elderly multiple myeloma patient：A case report
Provisionally accepted
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Introduction: The high prevalence of fatigue as an atypical clinical manifestation in general practice creates notable diagnostic challenges, particularly in geriatric patients. Methods: We describe a case of an 80-year-old female presenting with fatigue, initially attributed to poorly controlled diabetes mellitus or upper respiratory infection, who was ultimately diagnosed with multiple myeloma after admitted to the Department of General Medicine at a general hospital. Initial diagnostic workup including physical examination revealed the presence of anterior thoracic mass with undetermined etiology. Laboratory analysis demonstrated characteristic hematological abnormalities: normocytic anemia (hemoglobin 91 g/L), significant hyperglobulinemia (serum globulin 76.18g/L), and hypoalbuminemia (serum albumin 27.94g/L), showing a reversed albumin-globulin (A/G) ratio of 0.37. Guided by Murtagh's safe diagnostic strategy, comprehensive imaging studies including contrast-enhanced cervical, thoracoabdominal computed tomography (CT) and 18F-FDG PET-CT were performed. Histopathological confirmation was obtained from the gastric mass (CD138⁺/CD38⁺ plasma cell infiltration) and anterior mediastinal tumor (κ light chain restriction). Serum immunofixation electrophoresis revealed monoclonal IgA-κ paraprotein, while bone marrow aspiration demonstrated 80% clonal plasma cells. These findings collectively fulfilled the International Myeloma Working Group (IMWG) diagnostic criteria for multiple myeloma with extramedullary involvement. Results: The patient was transferred to Hematology Department for further therapy. Clinical reassessment at 6-week follow-up showed symptomatic improvement and anterior thoracic mass regression. Discussion: We report a diagnostic case study of a MM patient whose initial presentation was fatigue, and clinicians should prioritize the overall condition，reduce diagnostic delays and improve therapeutic outcomes through early intervention strategies.
Keywords: Fatigue, General Practice, Multiple Myeloma, Extramedullary, case report
Received: 30 May 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Li, Li and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Junrong Chen, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.