Multiple myeloma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Shyam Patel [3]

Overview

Multiple myeloma must be differentiated from monoclonal gammopathy of undetermined significance (MGUS), isolated plasmacytoma of the bone, and extramedullary plasmacytoma.

Differentiating Multiple Myeloma from other Diseases

• The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:

Differential Diagnosis Causes Features Therapy Multiple myeloma Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells Clonal plasma cell proliferation Diffuse bone pain and tenderness with osteolytic lesions Renal failure Hypercalcemia Anemia Induction chemotherapy with bortezomib, lenalidomide, and dexamethasone Bisphosphonates RANK ligand inhibitors (denosumab) Autologous stem cell transplantation Osteoporosis Imbalance between bone resorption and bone formation Preceded by osteopenia Decreased bone mineral density Acute musculoskletal pain if fractures develop Severe decrease in BMD on dual-energy X-ray absorptiometry (DEXA) test T score less than -2.5 on DEXA scan Calcium and vitamin D supplementation Bisphosphonates Weight-bearing exercise Teriparatide RANK ligand inhibitors (denosumab) Osteomalacia Inadequate mineralization of bone Deficiencies in vitamin D, calcium, or phosphorus Renal tubular acidosis Malabsorption Diffuse bone pain, fatigue, and fractures Low bone mineral density (BMD) Hypocalcemia Vitamin D3 supplementation Scurvy Vitamin C deficiency Malabsorption Hemodialysis Gum disease Loose teeth Easy bruising Vitamin C supplementation Citrus fruits Osteogenesis imperfecta Mutations in 'COL1A1 or COL1A2 Impaired type I collagen synthesis Short stature, scoliosis, and propensity for fractures Blue discoloration of sclera Bisphosphonates Physical therapy Surgical fixation of brittle bones Genetic counseling for offspring Homocystinuria Deficiency of cystathione beta synthase Deficiency of folate, vitamin B12, or vitamin B6 Diffuse bone pain and musculoskeletal symptoms High-dose vitamin B6 supplementation Betaine supplementation

References

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