Font Size: 

Introduction: Multiple myeloma is a challenging hematologic case to handle. Sometimes the disease is diagnosed too late for the patient and doctor. Therefore careful approaches are needed to manage the patient. Findings: A 66-year-old man suffers from low back pain since 1 year before he came to hospital. He was diagnosed multiple compression fracture by orthopedic and had undergone 2 surgeries in 1 year. Punched out lesion were found in skull radiology and lumbar compression in lumbar MRI. After further investigation, plasmacytoma and M protein in urine electrophoresis were found. Significant improvement found after bortezomib and dexamethasone were given. Discussion: Diagnosis and management of multiple myeloma is a challenge for a doctor. Systematically approach are needed for a patient with recurrent fracture. Even a novel therapies are not widely available in our country. Conclusion: We reported a late diagnosis of multiple myeloma and had a significant improvement after bortezomib and dexamethasone therapy. Keywords: late diagnosis, multiple myeloma, recurrent fracture.