Abstract
Multiple myeloma (MM) is a neoplastic disorder characterized by the monoclonal proliferation of plasma cells in the bone marrow. It is estimated to account for only 1% of neoplastic diseases, and there is still a great deal of uncertainty about its precise etiology. Common risk factors with a proven association with MM include ionizing radiation exposure, age greater than 65, male gender, and the presence of monoclonal gammopathy of unknown significance (MGUS).More recently, research has shown that occupational exposures to pesticides also have a significant association with the development of MM. We present the case of an adult male who presented with rib pain, back pain, fevers, and progressive shortness of breath and was ultimately found to have multiple myeloma thought to be associated with occupational exposure to the pesticide captan.
Highlights
Multiple myeloma (MM) is a malignant plasma cell disorder characterized by an aberrant expansion of plasma cells in the bone marrow that produces a monoclonal immunoglobulin [1]
The patient was visiting from the Dominican Republic, where he worked in agriculture and used the fungicide captan
One case-control study collected extensive information, including occupational history from 573 persons with newly diagnosed multiple myeloma, and developed a job-exposure matrix for pesticide exposure. They found that individuals who used herbicides and fungicides on a regular basis are one and a half times more likely to develop multiple myeloma than the general population and are eight times more likely to have the associated mortality [6]
Summary
Multiple myeloma (MM) is a malignant plasma cell disorder characterized by an aberrant expansion of plasma cells in the bone marrow that produces a monoclonal immunoglobulin [1]. The diagnosis of MM requires greater than 10% plasma cells on bone marrow biopsy and either increased monoclonal protein in the serum or urine or signs of end-organ damage [3]. The patient was visiting from the Dominican Republic, where he worked in agriculture and used the fungicide captan He reported an unintentional 12-pound weight loss and worsening back pain over the past month. Given the patient’s history of unintentional weight loss and numerous lytic lesions, laboratory workup for MM was initiated This revealed an elevated total serum protein level at 11.3 g/dL (normal range 6.4-8.3 g/dL), calcium level of 8.4 g/dL (normal range 8.4-10.2 g/dL), decreased albumin level of 2.5 mg/dL (normal range 3.5-5.2 mg/dL), and elevated b2-microglobulin level at 4.26 mg/L (0.8-2.6 mg/L). He was discharged after one week of inpatient treatment and scheduled for outpatient chemotherapy
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