The early clinical diagnosis of multiple myeloma is rendered difficult by the relative vagueness of the symptoms and by the scarcity of physical signs. The first symptoms are usually indefinite pains in the lower chest or the lumbosacral spine. Since the patient is usually in the fourth or later decades of life, these pains are apt to be regarded as being arthritic, myositic, or fibrositic in origin and are treated as such. Most patients, therefore, have increasing symptoms before a thorough investigation with careful urinalyses, blood studies, x-ray studies, serum protein determinations, and finally bone marrow studies establish the diagnosis. Albuminuria is a frequent finding, and renal failure is a common complication in well-defined cases.
In the following case an azotemia of unknown origin was the outstanding clinical feature without other indications of myeloma. The original problem was to explain an increased blood urea, and the correct diagnosis was only determined by methodical elimination of the various causes of azotemia. In retrospect, however, the history was more suggestive of the diagnosis than it appeared to be at first consideration.
A Greek restaurateur, age 42, was admitted to the Clinic August 6, 1942, with the chief complaint of nausea and vomiting of 3 weeks' duration. He stated that he had been well until the preceding June, at which time following heavy lifting he had experienced a very severe pain in the left costal margin and left lower chest. It had persisted for several days and had been associated with. . .