Uncommon Presentations of Multiple Myeloma

Abstract

Multiple myeloma is a rare malignancy that exhibits a wide range of possible clinical presentations. In recent years, with the advent of stem cell transplantation, the prognosis of patients with multiple myeloma has been increasing. We searched the literature for reports of atypical myeloma presentations to aid clinicians in formulating differential diagnoses and to increase the number of cases diagnosed early. There have been a number of reports of early ocular symptoms, including, but not limited to, proptosis, optic neuropathy, vision loss, retinal hemorrhage, and detachment. Neurological presentations included cranial nerve palsies, vertigo related to cerebellar involvement, and diabetes insipidus related to pituitary involvement. Among gastrointestinal manifestations, there are a number of reports of multiple myeloma presenting as acute and chronic pancreatitis. Mesenteric ischemia due to amyloidosis, acute abdomen, and hepatosplenomegaly were also among reported presentations. When it comes to renal involvement, while acute renal failure and proteinuria are typical, there are reports of patients presenting with both nephritic and nephrotic forms of glomerular disease, as well as end-stage renal disease requiring dialysis. We believe that it is essential for clinicians to keep reporting atypical multiple myeloma presentations and consider it as a possible diagnosis in a patient with serious, atypical symptoms.

Atypical Presentation of Plasma Cell Neoplasm of the Sternum

“…MM belongs to a family of monoclonal gammopathies; monoclonal gammopathy of undetermined significance (MGUS) and asymptomatic/smoldering myeloma accounting for about 1% of all cancers [ 1 ]. It is regarded as the most common primary bone cancer in older patients with a median age of onset of about 65 years [ 2 , 3 ]. In the United States, MM has an incidence of about 30,000 new cases per year, and in 2018, more than 10,000 people died of this disease [ 3 ].…”

“…It is regarded as the most common primary bone cancer in older patients with a median age of onset of about 65 years [ 2 , 3 ]. In the United States, MM has an incidence of about 30,000 new cases per year, and in 2018, more than 10,000 people died of this disease [ 3 ].…”

Multiple Myeloma Presenting as Chronic Diarrhea

“…Mechanisms by which MM can affect the GI tract are direct infiltration, amyloidosis, plasmacytoma, or hypercalcemia (inducing pancreatitis). 3 The organs most commonly involved are small bowel, followed by stomach, colon, and esophagus. 2 On imaging, GI lesions related to MM can appear as a large mass or bowel wall thickening, as seen in our patient.…”

“…Tissue biopsy is needed to confirm diagnosis because imaging findings are nonspecific and can resemble primary GI malignancies. 3 …”

Left Femur Neck Fracture and Left Eye Esotropia as Initial Clinical Presentations of Gastric Cancer in a 54-Year-Old Female Patient: A Case Report and Review of Literature

“…In the differential diagnosis of such presentation, it is important to include multiple myeloma as differential diagnosis as pattern mimics its clinical manifestation [ 15 , 16 ]. However, the laboratory workup done did not favor the diagnosis of multiple myeloma in this case.…”