From Macrocytic Anemia to Fulminant Multiple Myeloma: A Case of Rapid Progression with Cast Nephropathy and Septic Shock

Megan Woods, Dalton Lohsandt

Abstract: Multiple myeloma can be difficult to recognize early because patients may initially present with vague symptoms and nonspecific laboratory abnormalities. We present the case of a 61-year-old male who was initially evaluated for progressive fatigue and macrocytic anemia despite normal iron, vitamin B12, and folate levels, along with an unrevealing gastrointestinal workup. Over the following months, he developed persistent anemia, rising total protein and globulin levels, and worsening weakness. Further evaluation revealed acute kidney injury, marked hyperproteinemia, rouleaux formation, and monoclonal protein, leading to the diagnosis of IgG lambda multiple myeloma with cast nephropathy. Despite transfer to a tertiary care center, initiation of dialysis, and treatment with bortezomib and dexamethasone, his course was complicated by pneumonia, septic shock, respiratory failure, and ultimately death. This case emphasizes the importance of maintaining clinical suspicion for plasma cell dyscrasia in patients with unexplained anemia and elevated serum protein levels. Earlier recognition and diagnostic testing may allow for timely intervention before progression to renal failure and other life-threatening complications.

Keywords: multiple myeloma, cast nephropathy, acute kidney injury, monoclonal gammopathy, serum protein electrophoresis, anemia, delayed diagnosis

How to Cite?: Megan Woods, Dalton Lohsandt, "From Macrocytic Anemia to Fulminant Multiple Myeloma: A Case of Rapid Progression with Cast Nephropathy and Septic Shock", Volume 15 Issue 9, September 2026, International Journal of Science and Research (IJSR), Pages: 699-702, https://www.ijsr.net/getabstract.php?paperid=SR26810131209, DOI: https://dx.doi.org/10.21275/SR26810131209

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