A rare case of multiple myeloma with several atypical manifestations

Abstract

A 75-year-old woman presented asthenia and anemia after recurrent intestinal bleeding. Colonoscopy showed the presence of blood clots in the ascending colon, without active bleeding. During hospitalization, right toe cyanosis progressed to ischemic necrosis and was resistant to analgesics and vasodilators. The positron emission tomography-computed tomography scan showed a nodular thickening in the midfield of the right lung. Blood chemistry evidenced an Immunoglobulin (Ig) G-λ monoclonal peak. Multiple myeloma (MM) was diagnosed by bone marrow biopsy and serum/urine Ig-free chain dosage. The patient no longer had intestinal bleeding after the first MM chemotherapy (CHT). After 6 months of CHT, a partial hematological response and peripheral vascular improvement occurred. Extremely rare conditions may result in MM. In this case report, seemingly unrelated atypical manifestations co-existed and responded to hematological CHT for MM, confirming their association with the disease.

Keywords

• Multiple myeloma
• intestinal bleeding
• pulmonary amyloidosis
• toe ischemia