Q. Can multiple myeloma be misdiagnosed over chronic alcoholism?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
Published on Jan 28, 2017

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 or PET scan or bone marrow biopsy or urinalysis. The x-ray revealed some tiny pinholes in my jaw and skull but was too small to be definitive.

I should mention that I was an alcoholic and drink 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 the alcohol for four weeks. I am now feeling well with no physical symptoms of myeloma such as no fatigue or weakness, appetite is good, 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 over chronic alcoholism? Could I have been misdiagnosed? Can a definite diagnosis of myeloma be made from only blood tests and an x-ray?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hi,

Welcome to icliniq.com.

  • Blood work can strongly suggest myeloma; however, marrow biopsy is needed. But, one can fairly be sure about the diagnosis.
  • Before starting treatment one will need the bone marrow biopsy. Also, bony lesion if visible on x-ray, then one may proceed without MRI or PET scan.
  • Regarding your alcohol query, alcohol leads to diffuse bone damage and will not result in punched out lesions. So, I think less likely chance that you are misdiagnosed.
  • You can upload your blood reports so that light can be thrown over it.

Revert with the report to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Hi doctor,

I have uploaded my most recent blood and x-ray reports for you. I would very much like to hear your opinion.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

  • Your x-ray of the skull (attachment removed to protect patient identity) showing lytic lesions which are typical of myeloma and very unlikely to happen in alcohol intake.
  • Patients with otherwise asymptomatic myeloma who have an involved or uninvolved free light chain assay that is, kappa to lambda ratio of 100 or greater have a risk of progression to end organ damage in the next two years of approximately 80 percent.
  • Given the high rate of progression, a free chain ratio of 100 or more is now considered diagnostic of MM and treatment is indicated. Good thing in you is that you have not suffered any significant organ damage.
  • It is important to get treatment and follow your doctor's instructions about visits and tests. It is also important to talk to your doctor about any side effects or problems you have during treatment.
  • Various treatment options are chemotherapy, steroids, immunomodulatory agent and bone marrow transplant. All the best for further management and you can get back if you have any doubts.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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