Multiple myeloma was recognized as occupational disease No. 1318 in Germany following long-term benzene exposure in a distillery worker, illustrating the legal obligation of physicians to report suspected occupational diseases.
Key Findings
Background
An elderly male patient developed Multiple Myeloma stage II (R-ISS) with 13q-deletion after several decades of benzene exposure working in a distillery in the brewing industry.
Patient was 82 years old at first expert assessment and 84 years old at second expert assessment.
Initial presentation included approximately 20 kg weight loss over 3 months.
The patient worked 'for several decades in the brewing industry, mainly in a distillery' with benzene exposure.
Cytogenetic finding of 13q-deletion was identified alongside Multiple Myeloma stage II per R-ISS staging.
Results
Laboratory and imaging findings demonstrated moderate hematologic changes, elevated IgG-kappa light chains, and a heterogeneous bone matrix without clear focal osteolytic lesions.
Moderate hematologic changes were found on blood count.
Elevated free IgG-kappa light chains were detected in both serum and urine with an increased kappa/lambda ratio.
Elevated β2-microglobulin was also identified.
CT imaging revealed a 'markedly heterogeneous bone matrix without clear focal osteo lesions.'
Results
The patient was treated with vitamin D3 and calcium orally and zoledronic acid intravenously to improve bone density.
Vitamin D3 and calcium were administered orally.
Zoledronic acid was administered intravenously.
Treatment was directed at improving bone density in the context of myeloma-associated bone disease.
Results
The multiple myeloma was officially recognized as occupational disease No. 1318 according to Appendix 1 of the German Occupational Diseases Ordinance (Berufskrankheiten-Verordnung).
Recognition followed expert assessment (Begutachtung).
Occupational disease No. 1318 in Germany covers hematologic malignancies associated with benzene exposure.
This recognition entitles the patient to benefits from the statutory accident insurance (gesetzliche Unfallversicherung).
Discussion
Physicians are legally obligated in Germany to report suspected cases of occupational disease, and failure to do so may result in a high number of unreported cases and patients losing statutory insurance benefits.
Taking an occupational history is emphasized as a necessary clinical step.
The authors note that 'due to a lack of consideration, a high number of unreported cases and the loss of insurance benefits (statutory accident insurance) are possible.'
Adequate workplace safety is cited as a means to prevent hematologic malignancies and their economic consequences.
What This Means
This case report describes an elderly man in his 80s who was diagnosed with multiple myeloma — a type of blood cancer affecting plasma cells — after spending several decades working in a distillery where he was exposed to benzene, a known cancer-causing chemical. His initial symptom was dramatic weight loss of about 20 kg (44 lbs) over just three months. Blood and urine tests showed abnormal protein levels characteristic of multiple myeloma, and imaging revealed changes in his bone structure. He was diagnosed with stage II multiple myeloma and treated with medications to protect his bones.
This research suggests that benzene exposure in occupational settings, such as distilleries, can be a cause of multiple myeloma, and that such cases can qualify for legal recognition as occupational diseases in Germany under disease classification No. 1318. In this patient's case, the myeloma was officially recognized as work-related, making him eligible for statutory accident insurance benefits. The authors emphasize that doctors have a legal duty in Germany to report suspected occupational diseases and must routinely take a work history from their patients.
The broader implication of this case is that many similar cases may go unrecognized and unreported because physicians do not routinely ask about occupational exposures. This means affected workers may miss out on compensation they are legally entitled to. The paper highlights that better workplace safety measures and greater physician awareness could prevent benzene-related blood cancers and reduce both human suffering and economic costs.
Frei-Stuber L, Nowak D. (2026). [Multiple myeloma as an occupational disease after long-term benzene exposure in a distillery - a case report].. Deutsche medizinische Wochenschrift (1946). https://doi.org/10.1055/a-2868-1885