Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive bone pain, most notably in the lumbar spine and ribs, exacerbated by movement. Associated symptoms include unexplained fatigue, unintentional weight loss, and recurrent infections. No history of recent trauma. Review of systems positive for generalized weakness and bone tenderness.
Clinical Examination Findings
General: Pale conjunctiva, appears chronically ill. Musculoskeletal: Focal tenderness upon palpation of the thoracic and lumbar spine. Neurological: Intact sensation, no focal motor deficits. Skin: No evidence of petechiae or ecchymosis. Lymphatic: No palpable peripheral lymphadenopathy.
Treatment Protocol
Initiate systemic therapy with proteasome inhibitors and immunomodulatory agents. Administer intravenous bisphosphonates (e.g., Zoledronic acid) monthly to address bone lesions and prevent skeletal-related events. Monitor serum calcium, creatinine, and complete blood count. Consider orthopedic consultation for stabilization if high risk of pathological fracture.