title: [First manifestation of multiple myeloma as lethal streptococcal sepsis].
abstract: BACKGROUND
  The multiple myeloma has the highest incidence among tumors of the bone and the bone marrow. Due to its rather mild and uncharacteristic clinical onset, first diagnosis of multiple myeloma is often delayed.
  
  
  METHODS
  The case of a 60-year-old female patient is reported who had been admitted to the authors' hospital in a state of severe septicemia. The patient's medical history had been unremarkable, apart from osteoporotic complaints. Smears of both peripheral blood as well as bone marrow samples showed a massive streptococcal infestation as demonstrated by light microscopy. In addition, plasma cells were the dominant cell type in these samples allowing the diagnosis of a yet unknown full-blown multiple myeloma.
  
  
  CONCLUSIONS
  The case suggests that in the event of indistinct bone ache, a routine serum electrophoresis is advisable to minimize the risk of missing an underlying multiple myeloma.
authors.affiliation: Medizinische Klinik, St. Bernhard Hospital, Brake, Germany. dr.austein@sbhospital.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Austein
authors.forename: Holger
authors.initials: H
authors.lastname: Kerstan
authors.forename: Georg
authors.initials: G
authors.lastname: Aue
authors.forename: Inga
authors.initials: I
authors.lastname: Schnieder
authors.forename: Julia
authors.initials: J
authors.lastname: von Bloh
authors.forename: Stephanie
authors.initials: S
authors.lastname: Badge
mesh_terms: D001707:Biopsy, Needle; D001853:Bone Marrow / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D011008:Pneumococcal Infections / Q000209:etiology* / Q000473:pathology; D012772:Shock, Septic / Q000209:etiology* / Q000473:pathology