Dysphagia – A Rare Presentation of Multiple Myeloma
Gastroenterology and Hepatology from Bed to Bench,
8 March 2021
AbstractIntroduction: Dysphagia is a symptom with a broad differential diagnosis. Usually, the etiology of dysphagia is benign, but it is essential to rule out serious causes. It is also critical to think outside the box when the etiology is not obvious. We describe a case of multiple myeloma that initially presented with dysphagia.Case presentation: An 81-year-old male patient presented with dysphagia to solid food associated with anorexia and weight loss of 22 kg over the last 6 months. The patient looked chronically ill and cachectic. Upper endoscopy showed patchy erythema in the gastric antrum. Gastric biopsy was consistent with gastric amyloidosis. Although serum and urine protein electrophoresis did not show a monoclonal (M) band, immunofixation did show elevated free kappa light chains and elevated free Kappa/Lambda ratio. Bone marrow biopsy was consistent with multiple myeloma.Discussion: Although gastrointestinal involvement is common in amyloidosis, it is unusual for amyloidosis to initially present in the gastrointestinal tract. Identification and treatment of the underlying condition, e.g. multiple myeloma, can lead to regression of gastrointestinal amyloidosis.
- Multiple myeloma
- plasma cell disorders
- and dysphagia.
Carucci LR and Turner MA, Dysphagia revisited: common and unusual causes. Radiographics, 2015. 35(1): p. 105-22.
Achem SR and Devault KR, Dysphagia in aging. J Clin Gastroenterol, 2005. 39(5): p. 357-71.
Kahrilas PJ, Kishk SM, Helm JF, Dodds WJ, Harig JM, and Hogan WJ, Comparison of pseudoachalasia and achalasia. Am J Med, 1987. 82(3): p. 439-46.
Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al., Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc, 2003. 78(1): p. 21-33.
Kyle RA, Larson DR, Therneau TM, Dispenzieri A, Melton LJ, 3rd, Benson JT, et al., Clinical course of light-chain smouldering multiple myeloma (idiopathic Bence Jones proteinuria): a retrospective cohort study. Lancet Haematol, 2014. 1(1): p. e28-e36.
Michels TC and Petersen KE, Multiple Myeloma: Diagnosis and Treatment. Am Fam Physician, 2017. 95(6): p. 373-383.
Rajkumar SV, Gertz MA, and Kyle RA, Primary systemic amyloidosis with delayed progression to multiple myeloma. Cancer, 1998. 82(8): p. 1501-5.
Mitchell MA, Horneffer MD, and Standiford TJ, Multiple myeloma complicated by restrictive cardiomyopathy and cardiac tamponade. Chest, 1993. 103(3): p. 946-7.
Dahraoui S, Uwingabiye J, Belarj B, Biaz A, Rachid A, Dami A, et al., Unexpected discovery of multiple myeloma following cardiomyopathy. Clin Case Rep, 2018. 6(1): p. 86-90.
Sun L, Zhang L, Hu W, Li TF, and Liu S, Case report: One case of primary AL amyloidosis repeatedly misdiagnosed as scleroderma. Medicine (Baltimore), 2017. 96(50): p. e8771.
Tada S, Iida M, Yao T, Kawakubo K, Yao T, Okada M, et al., Endoscopic features in amyloidosis of the small intestine: clinical and morphologic differences between chemical types of amyloid protein. Gastrointest Endosc, 1994. 40(1): p. 45-50.
Cohen JA, An J, Brown AW, Spearman D, and Paredes A, Gastric Outlet Obstruction due to Gastrointestinal Amyloidosis. J Gastrointest Surg, 2017. 21(3): p. 600-601.
Park SW, Lee HW, and Cho EJ, Systemic amyloidosis manifested by gastric outlet obstruction. Clin Endosc, 2013. 46(5): p. 579-81.
Tuomaala H, Karppa M, Tuominen H, and Remes AM, Amyloid myopathy: a diagnostic challenge. Neurol Int, 2009. 1(1): p. e7.
Tada S, Iida M, Iwashita A, Matsui T, Fuchigami T, Yamamoto T, et al., Endoscopic and biopsy findings of the upper digestive tract in patients with amyloidosis. Gastrointest Endosc, 1990. 36(1): p. 10-4.
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