Consider panculture and urinalysis. Multiple myeloma is complicated frequently by infections. In nonneutropenic patients, infections are usually secondary to Streptococcus pneumoniae or Haemophilus influenzae . Search for other disorders. Head CT scan is indicated if the patient presents with altered level of consciousness, seizures, or focal neurologic deficits.
Contrast dye is contraindicated in multiple myeloma because of the increased risk of renal failure.
Chest radiograph may be indicated to rule out infection. High output failure can be caused by hyperviscosity or anemia. Plasmapheresis is the treatment of choice for hyperviscosity syndrome. As plasmapheresis removes the circulating paraproteins, the serum viscosity decreases and symptoms improve. Although symptoms of CHF from hyperviscosity may not respond to standard therapies, plasmapheresis reverses these symptoms.