Asian Journal of Case Reports in Medicine and Health

Aim: We aim to highlight this rare presentation to alert clinicians to atypical multiple myeloma (MM) cases, enabling earlier diagnosis and better patient outcomes. This report may contribute to the medical literature by illustrating how MM can masquerade as other conditions in absence of characteristic clinical features, leading to potential diagnostic dilemmas and pitfalls, hence, encouraging clinicians to maintain high index of suspicion, particularly in unusual demographics. This helps identify patterns or variations and stimulates further investigations into MM's different presentation and progression.

Presentation of Case: This article features a 36-year-old female with an initial presentation of fever, multiple symmetrical joint pains, oral ulcer, and alopecia with no hypercalcemia or lytic bone lesions, and provisional diagnoses of connective tissue disorders, lymphoma, leukemia, and infectious etiologies but confirmatory tests conclusive of MM.

Discussion: MM, a clonal plasma cell proliferative disorder, usually presents with osteolytic bone lesions accompanied by hypercalcemia, anemia, and/or renal dysfunction. It predominantly affects elderly males, with a median diagnosis age of 70. MM is rare under 40, creating less suspicion and delayed diagnosis. However, age is a pivotal prognostic feature because of its associated comorbidities and performance index; thus, young patients have a better prognosis, making early diagnosis even more important.

Conclusion: The consequences of undiagnosed MM are severe and show an increased risk of death underlining the cruciality of quick diagnosis with a Sherlockian mindset and interdisciplinary approach for lowering morbidity. This case underscores the importance of considering MM in differential diagnoses, even when it seems unlikely.