- 期刊
以胸痛表現之多發性骨髓瘤病例報告
A Case Study of Multiple Myeloma Presenting with Chest Pain
摘要
本病例報告為一位65歲男性，因胸痛至心臟科及腸胃科門診求診數次，在排除心血管及腸胃問題後胸痛仍未改善，且因合併咳嗽及呼吸喘，至胸腔科門診診斷為肺炎。經口服抗生素治療後仍感呼吸喘且胸痛加劇，並合併有食慾變差及身體無力，進而至急診就醫並住院。住院期間除了感染控制，更進一步針對其症狀如不明原因疼痛，安排神經科會診以排除神經學問題；針對影像上的蝕骨性損害及不明原因貧血，會診血液腫瘤科以排除惡性腫瘤，在經過血液檢查及骨髓切片，最後確診為多發性骨髓瘤。病患雖有貧血以及骨頭損害，但所幸尚未造成高血鈣及腎衰竭。從症狀開始至確立診斷歷經約兩個月的時間，在接受化學治療後症狀緩解，病情穩定出院。當病人有胸痛的臨床表現，經由詳細的病史與身體評估，在第一時間排除致命性的急症後，若發現有合併不明原因貧血、骨頭有蝕骨性損害、高血鈣或腎衰竭，就需高度懷疑多發性骨髓瘤的可能性，藉由影像與實驗室報告的輔助，避免延遲診斷與治療而造成不可逆的合併症。
並列摘要
This case study presents a 65 year-old man who suffered from chest pain and had been referred to both the outpatient departments of cardiology and gastroenterology several times but in vain. His chest pain still persisted and was accompanied by cough and dyspnea. Pneumonia was then diagnosed by a chest physician, however, oral antibiotics treatment did not relieve his chest pain. He also experienced a loss of appetite and general weakness. Subsequently, he was admitted to the emergency room and hospitalized. During hospitalization, we consulted a neurologist and a hematologist due to osteolytic rib lesion and general weakness. The final diagnosis was multiple myeloma. The patient's condition improved after receiving anti-myeloma therapy and was discharged. When a patient presents with chest pain, potentially fatal diseases should be excluded first. If the patient presents with unexplained anemia, osteolytic bone lesions, hypercalcemia, and renal function impairment at the same time, then multiple myeloma must be highly suspected. With the assistance of image study and laboratory tests, earlier diagnosis and treatment is advised.