26th August 2020

A 67-year-old man presents to A&E with sudden onset, right thigh pain which came on after a fall from standing height

A 67-year-old man presents to A&E with sudden onset, right thigh pain which came on after a fall from standing height. X-ray imaging shows lytic lesions and a pathological femoral shaft fracture. Aside from the sudden-onset pain, he describes a 3-4 month history of generalised bone pains and 6 months of fatigue. He feels his clothes fit looser now, although he has not been trying to lose weight. 

On examination, there is an enlarged tongue and bruises on the back. When questioned, the gentleman denies tongue pain, and he had not realised the bruises were there. Which of the diagnoses below best explains all of the symptoms in this gentleman’s presentation? Select ONE option only.