Sciatica as an atypical initial presentation of multiple myeloma: a case report.

Background: Vertebral involvement in multiple myeloma is a frequent cause of morbidity and is associated with severe pain, spinal deformity, and neurological compromise. While back pain is a common presenting feature, sciatica as an initial manifestation of multiple myeloma is extremely rare, particularly in patients without a history of trauma or osteoporotic risk factors. Recognizing such atypical presentations is crucial for timely diagnosis and management. Case Description: A middle-aged male with no significant medical history presented with a two-month history of progressive sciatica radiating bilaterally to the lower limbs, without preceding trauma, fever, or infection. Imaging revealed multiple vertebral compression fractures, and laboratory studies demonstrated anemia, hypercalcemia, renal dysfunction, and elevated inflammatory markers. Bone marrow biopsy and serum protein electrophoresis confirmed the diagnosis of multiple myeloma. The patient was managed conservatively with analgesia, spinal bracing, and correction of metabolic abnormalities. Vertebroplasty was advised for long-term spinal stabilization, and he was subsequently referred for chemotherapy under hematology, nephrology, and oncology joint care. Conclusions: This case emphasizes the importance of considering multiple myeloma in the differential diagnosis of persistent or atypical sciatica, especially in non-osteoporotic or younger individuals. Early recognition of such presentations allows for prompt investigation and multidisciplinary management, improving patient outcomes. Vertebroplasty remains a valuable adjunct in achieving pain relief and functional recovery in multiple myeloma-related vertebral fractures.