8th July 2024

A 75-year-old male presents with a few week’s history of lethargy and back pain

A 75-year-old male presents with a few week’s history of lethargy and back pain. Investigations show: Hb 87 g/L (115-165), WBC 6.4×10⁹/L (4-11), Neutrophil 3.1×10⁹/L (2-8), Platelet 190×10⁹/L (150-400), Na138 mmol/L (135-145), K 4.9 mmol/L (3.5-5), Urea 10.4mmol/L (2.5-7.5), Creatinine 250 μmol/L (60-110), CRP 18 mg/L (<5) . Bilirubin 17 μmol/L (<21), ALT 30 U/L (<41), ALP 190 U/L (30-130), Calcium 2.88 mmol/L (2.20-2.60). Urine dipstick is negative for protein and blood. A US KUB showed normal sized kidneys with no hydronephrosis. What is the most likely diagnosis in this case?

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