An unusual case of multiple myeloma

Abstract

The case concerns the unusual presentation of a non-secretory multiple myeloma with diarrhoea secondary to large bowel infiltration. In December 2009, a 74-year-old lady presented to hospital and complained of a two year history of intermittent diarrhoea which had been worsening over a three month period. She also had sustained a deep vein thrombosis and was investigated for pulmonary embolism. Routine blood investigations showed a raised ESR & CRP and a normochromic normocytic anaemia. Urea and electrolytes, liver function tests, calcium, phosphate and albumin where all normal, creatinine was elevated. Serum protein electrophoresis was normal at presentation. Chest X-ray revealed lytic rib and vertebral lesions which were followed by CT scan and MRI. Colonic biopsy revealed a plasma cell infiltration and rib trucut biopsy revealed plasmacytoma. Bone marrow biopsy confirmed Multiple Myeloma. This is a plasma cell disorder that characterised by abnormal proliferation and accumulation in the bone marrow. Typically it is accompanied by monoclonal protein in the serum and/ or urine and consequent tissue damage such as kidney failure and pathological fractures due to bone damage.