Multiple myeloma masquerading as ascites: a rare case report

B. P. Priyadarshi; Mahendra Singh; Ashok K. Verma; Rishibha Kaushik

doi:10.18203/2349-3933.ijam20252539

Authors

B. P. Priyadarshi Department of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
Mahendra Singh Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India
Ashok K. Verma Department of Radiology, GSVM Medical College, Kanpur, Uttar Pradesh, India
Rishibha Kaushik Department of Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20252539

Keywords:

Amyloidosis, Ascites, Multiple myeloma

Abstract

A 45-year-old woman with progressive abdominal distension was diagnosed with multiple myeloma after presenting with unexplained ascites. Investigations revealed anemia, hypercalcemia, renal dysfunction, lytic bone lesions, and 62% atypical plasma cells in bone marrow. Liver biopsy showed amyloid deposition, suggesting amyloidosis-induced hepatic dysfunction as the cause of ascites. Other causes, including portal hypertension and malignancy, were ruled out. Myelomatous ascites is rare and requires high suspicion for diagnosis. This case highlights the importance of considering multiple myeloma in unexplained ascites, as early recognition and treatment can significantly improve patient outcomes.

Metrics

Metrics Loading ...

References

Kintzer JS, Rosenow EC. Extramedullary plasmacytomas and multiple myeloma. Mayo Clin Proceed. 1978;53(10):603-8.

Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med. 2004;351(18):1860-73. DOI: https://doi.org/10.1056/NEJMra041875

Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-48. DOI: https://doi.org/10.1016/S1470-2045(14)70442-5

Gertz MA. Immunoglobulin light chain amyloidosis: 2020 update on diagnosis, prognosis, and treatment. Am J Hematol. 2019;94(12):1337-45.

Wechalekar AD, Gillmore JD, Hawkins PN. Systemic amyloidosis. The Lancet. 2016;387(10038):2641-54. DOI: https://doi.org/10.1016/S0140-6736(15)01274-X

Dispenzieri A. How I treat AL amyloidosis. Blood. 2012;119(7):1805-13. DOI: https://doi.org/10.1182/blood-2012-03-378992

Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med. 2003;349(6):583-96. DOI: https://doi.org/10.1056/NEJMra023144

Palladini G, Merlini G. Current treatment of AL amyloidosis. Curr Opin Oncol. 2016;28(1):30-40.

Karahan O, Akbulut S, Yilmaz Y, Unal B. A case of myelomatous ascites due to plasma cell infiltration of the liver. Int J Hematol Oncol. 2013;23(1):45-8.

Comenzo RL, Reece D. Treatment of multiple myeloma: Current concepts. Blood. 2016;128(3):295-308.