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Rare Case of Smoldering Multiple Myeloma Coexisting With Gastrointestinal Amyloidosis

By: Vanessa A. Carter, BS
Posted: Wednesday, May 11, 2022

Jun Wu, MD, of The Affiliated Hospital of Qingdao University, Shandong Province, China, and colleagues examined an unusual case of smoldering multiple myeloma presenting with gastrointestinal symptoms in the World Journal of Clinical Cases. Based on the endoscopic findings of granular-appearing mucosa, submucosal hematoma, and ecchymosis, and later confirmed by Congo red staining, the patient was determined to have gastrointestinal amyloidosis.

“This case highlights that a high index of suspicion is required to diagnose gastrointestinal amyloidosis,” concluded the investigators. “It should be suspected in elderly patients with endoscopic findings of granular-appearing mucosa, ecchymosis, and submucosal hematoma. Timely diagnosis and appropriate therapy can help to improve the prognosis of these patients.”

A 63-year-old woman presented with abdominal distention, abdominal pain, hematochezia, and lower limb edema. Hyperemia, gastric retention, gastric angler mucosal coarseness, and mild oozing of blood was found via gastroscopy. Additionally, a colonoscopy uncovered hyperemic and edematous mucosa of the sigmoid and distal ascending colon. Hematoma, submucosal ecchymosis, and multiple round irregular ulcers were also seen during colonoscopy. Furthermore, multiple myeloma was diagnosed by immunohistochemistry and bone marrow biopsy.

The patient did not present with anemia, renal dysfunction, bone lesions, hypercalcemia, or malignancy biomarkers defined as more than 60% of plasma cells in bone marrow. Interestingly, the individual also had no presence of bone marrow lesions by MRI or elevated serum free light chain ratio detected. Ultimately, she was diagnosed with smoldering multiple myeloma coexisting with gastrointestinal amyloidosis.

The patient was administered chemotherapy and was eventually discharged once symptoms were relieved. She was doing well at the most recent follow-up of 5 years after chemotherapy. According to the authors, this is notably the best prognosis among any reported cases of multiple myeloma with gastrointestinal amyloidosis.

Disclosure: The study authors reported no conflicts of interest.

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