A 79-year-old pastor presents to the emergency department complaining of pain in his neck. He feels like he is too weak to preach to his congregation. He can barely keep his strength for more than a minute. Upon further questioning, he also reveals that he has suffered from two episodes of pneumonia over the past three months. You ordered some investigative studies. A neck x-ray demonstrates punched-out lytic lesions in the posterior skull. When you saw his laboratory studies, you suspected multiple myeloma and wondered whether he developed a paraneoplastic effect of this tumor. Of the following, multiple myeloma is associated with which paraneoplastic and distant effect of tumor?
