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Spontaneous bilateral fracture of the proximal humerus: an unusual presentation of multiple myeloma.

We report the case of a manwho presented with bilateral fracture ofthe upper end of the humerus, andwhose subsequent work-up revealed anadvanced stage of multiple myeloma.Case reportA 49-year-old man presented with com-plaints of bilateral shoulder pain and in-ability to use both upper limbs for 1week. There was no history of significanttrauma or pain. On examination, theproximal humeral region was tender andswollen bilaterally, and both hip jointswere also tender. Radiographs revealeddestruction of the upper ends of bothhumeri, with pathologic fracture (Fig. 1a,b) and multiple punched out lesions inproximal femora and pelvic bones, alongwith fracture of superior and inferior rightpubic rami (Fig. 1c). A provisional diag-nosis of multiple myeloma or metastaseswas considered, and both the upper limbswere splinted. The patient also had severepallor, and tenderness was noted in thelower dorsal spine and pelvic bones. Achest radiograph appeared normal. Skele-tal survey revealed lytic areas in the skull,clavicles, scapulae, ribs and spine, withcollapse of the 12th thoracic vertebra(Fig. 2a, b). Laboratory tests gave the fol-lowing values: hemoglobin 65 g/L, totalleukocyte count 6.4 × 10