We discuss a 31-year-old male who presented to the emergency room with a five-week history of dyspnea, chest pain, and right upper quadrant abdominal pain. Chest X-ray revealed a pleural opacity in the right lower hemothorax. Computed tomography (CT) of the chest showed a lytic rib lesion corresponding to the pleural lesion and multiple lytic lesions throughout the skeleton. Further labs revealed corrected calcium 4.43 mmol/L, total protein 115 g/L, creatinine 621 micromol/L, and urea 23.6 mmol/L. He had no prior labs for comparison. Subsequent bone marrow biopsy revealed a 50% involvement of plasma cells, which was consistent with a diagnosis of multiple myeloma (MM), and he was initiated on clone reduction therapy, with an excellent renal response but a partial hematologic response. This paper emphasizes that MM, though rare, should be in the differential diagnosis of acute kidney injury (AKI), as in this young adult.

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