Could my chronic alcoholism mimic multiple myeloma?

Question

Hi doctor,

I am a 63-year-old male. I have been recently diagnosed with multiple myeloma. My doctor, who is listed as a hematologist or oncologist, said that I must undergo chemotherapy asap. His diagnosis was based solely on bloodwork and a full skeletal x-ray. There was no MRI, PET scan, bone marrow biopsy, or urinalysis. The X-ray revealed some tiny pinholes in my jaw and skull, but they were too small to be definitive.

I should mention that I was an alcoholic and drank 24 to 30 regular beers per week. I have done some research and found that the bloodwork of a chronic alcoholic is similar to the bloodwork of someone with myeloma. Among other things, alcohol can cause damage to bone marrow and cause bone loss. I have since completely stopped drinking and have been off alcohol for four weeks.

I am now feeling well with no physical symptoms of myeloma, such as no fatigue or weakness, good appetite, no significant weight loss, no skin lesions, and no bone or back pain. No bloodwork has been done since I stopped drinking. Can multiple myeloma be misdiagnosed as chronic alcoholism? Could I have been misdiagnosed? Can a definite diagnosis of myeloma be made from only blood tests and an X-ray?

Kindly help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Blood tests can provide compelling indications of myeloma; however, a marrow biopsy remains essential for confirmation. While a diagnosis can be reasonably presumed, it's imperative to undergo a bone marrow biopsy prior to commencing treatment. If visible on an X-ray, bony lesions may allow progression without necessitating an MRI (magnetic resonance imaging) or PET (positron emission tomography) scan.

Addressing your query about alcohol, it's worth noting that alcohol primarily leads to diffuse bone damage rather than resulting in punched-out lesions. Hence, the likelihood of a misdiagnosis is diminished. If you're comfortable, you can share your blood reports to shed more light on the situation.

I hope this helps you.

Take care.

Answer 2

Hi,

Welcome back to icliniq.com.

The X-ray of your skull reveals lytic lesions, a pattern typical of myeloma, which is highly unlikely to be caused by alcohol intake. In cases of asymptomatic myeloma, individuals with an involved or uninvolved free light chain assay, specifically a kappa to lambda ratio of 100 or higher, face a substantial 80 percent risk of progressing to end-stage organ damage within the next two years.

Given this considerable progression risk, a free chain ratio exceeding 100 is now recognized as diagnostic for Multiple Myeloma (MM), prompting the need for treatment. Encouragingly, you haven't experienced significant organ damage thus far. It's crucial to initiate treatment and adhere to your doctor's guidance regarding appointments and tests.

Additionally, it's important to communicate any treatment-related side effects or concerns to your doctor. Treatment options encompass chemotherapy, steroids, immunomodulatory agents, and potentially a bone marrow transplant. Best wishes for your ongoing management, and don't hesitate to reach out if you have any uncertainties.

I hope this helps you.

Take care.