Multiple myeloma in a patient with primary hyperparathyroidism

A 50-year-old man presented with knee pain and general fatigue and was found to have severe hypercalcemia and renal failure. Hyperparathyroidism was suspected by hypercalcemia and a nodular lesion of the thyroid gland with CT-scan of the patient's neck. Exploration of the neck disclosed two slightly enlarged parathyroid glands. After surgery, the patient's serum calcium levels remained normal for two weeks, but after that his serum calcium levels rose again and renal failure continued. So needle biopsy of the kidney was enforced, and myeloma of the kidney was suspected. Multiple myeloma was diagnosed by bone marrow puncture.