Bacterial Meningitis as the First Presentation of Multiple Myeloma

Abstract

Multiple myeloma (MM) is a monoclonal gammopathy. Patients with MM are vulnerable to infections, especially by encapsulated bacteria. These infections have been associated with severe morbidity and mortality in MM. A key underlying cause of the immune system's decline in MM is insufficient production of polyclonal immunoglobulin, which manifests as severe hypogammaglobulinemia. An acute bacterial infection is rarely the first sign of the disease. We present a case of a 65-year-old male who presented to us with fever and disorientation. Clinical examination revealed signs of meningeal irritation. Cerebrospinal fluid study confirmed bacterial meningitis. Associated features such as renal failure, high erythrocyte sedimentation rate, hyperglobulinemia, and anemia lead to suspicion of MM which was later confirmed by serum electrophoresis.