以非特異性症狀就診之多發性骨髓瘤：個案報告

Non-specific Clinical Presentation of Multiple Myeloma: A Case Report

林友菁(Yu-Ching Lin) ； 張家銘(Chia-Ming Chung) ； 張肇松(Chao-Sung Chang) ； 白惠文(Hui-Wen Pai) ； 吳晉祥(Jin-Shang Wu) ； 林季緯(Chi-Wei Lin)

《台灣家庭醫學雜誌》 25卷4期 (2015/12) Pp. 263-270

https://doi.org/10.3966/168232812015122504005

摘要

多發性骨髓瘤為漿細胞增生造成之惡性疾病，好發於老年人，在台灣是第三常見的血癌。疾病早期臨床症狀多以骨骼疼痛、頭暈疲倦、全身無力、或反覆性感染等非特異性主訴求診，因為疾病症狀的非特異性、加上老人常有多重共病等因素，有極高比率延遲診斷，以致於多發性骨髓瘤診斷時多已發生各種併發症，如腎臟衰竭、壓迫性骨折等，進而影響預後。過去十年來醫學在多發性骨髓瘤治療上有明顯的進步，早期診斷、介入治療可以明顯提升病人的生活品質、甚至有效提高存活率。本文報告一名83歲男性，背部疼痛就診，症狀治療數月後，陸續出現疲倦、嗜睡、對外界刺激反應差、功能性退化及意識改變，入院後處理高血鈣急症並尋找高血鈣之誘發因子，最後經骨髓穿刺及切片檢查及確認為多發性骨髓瘤。本文以文獻回顧探討延遲診斷的原因及可能導致的問題，並提出適當的臨床建議，加強對多發性骨髓瘤早期症狀的警覺性，避免併發症的出現及改善病人預後。

關鍵字

共病 ； 延遲診斷 ； 老年人 ； 多發性骨髓瘤 ； 漿細胞瘤

並列摘要

Commonly seen in elderly people with clinical features of osteolytic bone lesions, renal impairment and anemia, multiply myeloma is a neoplastic disorder characterized by proliferation of a single clone of plasma cells derived from B cells. In addition to causing bone pain that drastically impairs patients' quality of life, it also predisposes them to pathological fracture, renal failure, infection, and subsequent mortality. Advances in multiple myeloma therapy during the past two decades have markedly reduced the associated complications and mortality as well as improved the patients' quality of life. However, non-specific symptoms and signs of multiple myeloma, which are similar to the common physical complaints of the elderly, often result in delayed diagnosis adversely affecting clinical outcome. The study reports an 83-year-old man presenting with bone pain, mild anemia and renal function impairment followed by impaired consciousness and activities of daily living. The cause of hypercalcemia, which was later noted, was extensively investigated. After excluding the possibilities of hyperparathyroidism and other malignancies, the diagnosis of multiple myeloma was confirmed by bone marrow biopsy. This case highlights the importance of early awareness of the diagnosis in primary care for timely treatment.

並列關鍵字

comorbidity ； delay ； elderly ； multiple myeloma

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