Shoulder Pain in a 33-Year-Old Male Found to Have Multiple Myeloma

Multiple myeloma (MM) is a blood cancer involving monoclonal plasma cells, mainly diagnosed in older adults. Only a very small percentage of patients are diagnosed before age 40. A 33-year-old male presented with hip and shoulder pain and was diagnosed with Immunoglobulin G (IgG) kappa multiple myeloma. Of the CRAB (calcium elevation, renal insufficiency, anemia, and bone lesions) criteria, he only exhibited anemia and bone lesions. He was found to have extensive osseous lesions throughout his skeleton and a bone marrow biopsy showing plasma cell myeloma involving 30% of medullary cellularity. He was started on therapy with daratumumab, lenalidomide, bortezomib, and dexamethasone, along with palliative radiation. Four months after his diagnosis, he underwent a successful autologous hematopoietic stem cell transplant, with recovery of his cell lines and improvement in his lab indices. MM frequently exhibits non-specific symptoms like anemia, bone pain, fatigue, weight loss, and renal issues. This can cause it to be overlooked, resulting in delays in diagnosis and treatment, which increase morbidity and mortality. The challenge is greater when MM appears in younger patients, as its rarity leads to lower consideration. Physicians must maintain a high level of suspicion to diagnose and treat MM promptly, particularly in younger groups.