What is the likely differential diagnosis for a 51-year-old patient with a background of multiple myeloma, presenting with vomiting, bloating, lactic acidemia (lactaemia), and severe sepsis?

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Differential Diagnosis for 51-year-old with Multiple Myeloma

Single Most Likely Diagnosis

  • Tumor Lysis Syndrome (TLS): Given the patient's background of multiple myeloma and presentation with vomiting, bloating, lactaemia (elevated lactate levels), and severe sepsis, TLS is a highly plausible diagnosis. TLS can occur in patients with multiple myeloma due to rapid cell turnover, leading to the release of intracellular contents into the bloodstream, which can cause metabolic derangements and organ damage.

Other Likely Diagnoses

  • Sepsis due to Infection: Patients with multiple myeloma are immunocompromised, making them susceptible to infections. The presence of severe sepsis could be due to a bacterial, viral, or fungal infection, which is a common complication in these patients.
  • Gastrointestinal Obstruction or Ischemia: The symptoms of vomiting and bloating could indicate a gastrointestinal obstruction or ischemia, which might be related to the multiple myeloma itself (e.g., amyloidosis affecting the gut) or a separate issue.
  • Hypercalcemia of Malignancy: Multiple myeloma can lead to hypercalcemia due to bone destruction, which might contribute to the patient's symptoms, including vomiting and altered mental status.

Do Not Miss Diagnoses

  • Adrenal Insufficiency: Patients with multiple myeloma may have adrenal insufficiency due to infiltration of the adrenal glands by myeloma cells or due to treatment effects. This condition can present with nonspecific symptoms, including vomiting and can be life-threatening if not promptly recognized and treated.
  • Pulmonary Embolism: Immunocompromised patients are at an increased risk of thromboembolic events. A pulmonary embolism could present with nonspecific symptoms, including vomiting, and is crucial to diagnose early due to its high mortality rate.

Rare Diagnoses

  • Amyloidosis: While not the most common initial presentation, amyloidosis can occur in patients with multiple myeloma and affect various organs, including the gastrointestinal tract, leading to symptoms like vomiting and bloating.
  • Multiple Myeloma-associated Amyloid Light-chain (AL) Amyloidosis with Cardiac Involvement: This condition can lead to heart failure, which might present with nonspecific symptoms, including vomiting and lactaemia due to decreased cardiac output and subsequent tissue hypoperfusion.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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