Steven Needell/Science Source
A 74-year-old man presents to the emergency department with sudden onset of severe pain in his left thigh, a 3-month history of unexplained weight loss and general weakness, and progressive difficulty in walking for the past 3 weeks. The patient states that he has always been in excellent health and he has not seen a physician in at least 10 years. Cachexia is noted on physical examination. Laboratory findings include hemoglobin, 12.4 g/dL; white blood cells, 8.12 cells/µL; platelets, 310,000 cells/µL; creatinine, 1.4 mg/dL; sodium, 137 mmol/L; potassium, 4.4 mmol/L; calcium, 10.1 mg/dL; prostate-specific antigen, 31 ng/mL; aspartate aminotransferase, 37 IU/L; and gamma-glutamyltransferase, 16 IU/L. Proteinuria and hematuria are detected by urinalysis. CT reveals multiple diffuse osteoblastic lesions in the right proximal femur.
