Last update:
24-May-2026

The purpose of this report is to describe the clinical presentation of multiple myeloma with CRAB (hyperCalcemia, Renal impairment, Anemia, Bone lesion) manifestations and emphasize the importance of a multimodal evaluation. A 51-year-old male presented with complaints of fatigue, excessive sleepiness, chronic back pain, and pain in the right lower rib. Physical examination revealed pale conjunctiva, while vital signs were within normal limits. Laboratory findings showed normochromic normocytic anemia (hemoglobin [Hb] 11.4 g/dL), elevated urea (57 mg/dL) and creatinine (2.06 mg/dL), hypercalcemia (2.5 mmoL/L), as well as proteinuria and hematuria. Non-contrast thoracic computed tomography (CT) demonstrated multiple lytic lesions in the scapula, sternum, ribs, and spine, whereas abdominal CT revealed lytic lesions and osteopenia in the lumbosacral and pelvic bones. Immunological testing detected elevated free light chain kappa (329.88 mg/L) with a kappa/ lambda ratio of 117.40. Bone marrow aspiration showed 90.5% plasmocyte dominance with immunohistochemistry positive for CD38, CD56, CD138, and kappa. Serum protein electrophoresis revealed an M-spike characteristic of multiple myeloma. In conclusion, this case illustrates that multiple myeloma may present with nonspecific symptoms, but diagnosis is established through a combination of laboratory, radiological, immunological, and histopathological evaluations. A multimodal approach is crucial for early detection and prevention of more severe organ complications.

Key words: Anemia, Hypercalcemia, Multiple myeloma, Plasma cell myeloma, Renal insufficiency.