Comprehensive Diagnostic and Therapeutic Approach to Groin Pain Revealing Multiple Myeloma with Bone Metastases

Abstract

This case report illustrates the diagnostic complexity and therapeutic success in a patient presenting with persistent groin pain that evolved into a systemic malignancy diagnosis. Initially attributed to Lumbar Disc Protrusion at L5, the patient’s symptoms worsened despite initial treatments for suspected Rheumatoid Arthritis (RA). Persistent discomfort prompted advanced imaging, including pelvic MRI and PET-CT, which revealed widespread bone metastases involving the cervical spine, lumbar spine, ischium, sternum, and flat bones. Laboratory investigations, including electrophoresis and Bone Marrow Aspiration (BMA), led to a diagnosis of Monoclonal Gammopathy of Undetermined Significance (MGUS), raising suspicion for Multiple Myeloma (MM). Chemotherapy was initiated with a tailored 21-day cycle regimen, adjusted for laboratory findings and complications such as elevated liver enzymes. Therapeutic success was evidenced by improved imaging, which showed resolution of cervical and lumbar lesions and significant reduction in ischium metastases, alongside declining serum electrophoresis levels. Multidisciplinary collaboration involving rheumatology, oncology, hematology, and orthopedic specialists ensured comprehensive care, while psychological support addressed the patient’s emotional challenges. This case highlights the importance of a structured diagnostic approach and individualized treatment in managing complex oncological presentations, demonstrating significant recovery potential with advanced therapeutic interventions.