A Rare Case of Extramedullary Relapse of Multiple Myeloma Causing Bowel Obstruction

Abstract

Extramedullary myeloma, defined by presence of plasma cells outside the bone marrow, is a rare entity accounting for about 3–9% of all cases. It usually is aggressive with a median survival of <6 months. It is also associated with adverse prognostic factors including 17p deletions and high-risk gene profiles. While common extramedullary sites include bones, there have been several case reports of hematogenous extramedullary myeloma to the liver, lungs, pancreas, breast, skin, and soft tissues. Extramedullary myeloma to the mesentery is a rare entity with only a handful of cases reported. We present a case of 69-year-old man presenting with relapse of multiple myeloma to the mesentery, resulting in bowel obstruction to highlight the various presentations of myeloma.

Duodenal Ulcer with Massive Gastrointestinal Hemorrhage as an Initial Manifestation in Multiple Myeloma with Extramedullary Disease: A Case Report

“…Furthermore, defective primary hemostasis was observed in patients with high serum β2-microglobulin and serum-free light chains, suggestive of a very active disease, which may be reflective of increased bleeding tendencies, as explained by Hinterleitner et al [6]. Small bowel obstruction may also be involved in patients presenting with EMP, causing tethering of the bowel loops owing to plasma cell infiltration into the peritoneum [7,8]. Meanwhile, previous studies revealed that hypercalcemic crisis resulted in paralytic ileus, which may be a deteriorating factor contributing to decreased bowel motion [9,10].…”