Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2307-2314
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2307
Gastrointestinal amyloidosis in a patient with smoldering multiple myeloma: A case report
Ai-Ling Liu, Xue-Li Ding, Hua Liu, Wen-Jun Zhao, Xue Jing, Xuan Zhou, Tao Mao, Zi-Bin Tian, Jun Wu
Ai-Ling Liu, Xue-Li Ding, Hua Liu, Wen-Jun Zhao, Xue Jing, Tao Mao, Zi-Bin Tian, Jun Wu, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Xuan Zhou, Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Author contributions: Zhao WJ, Jing X, and Zhou X contributed to the manuscript investigating; Liu AL, Ding XL, and Liu H wrote original draft; Tian ZB, Mao T, and Wu J contributed to the reviewing and editing.
Informed consent statement: Written informed consent from the patient was obtained.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Wu, MD, Chief Doctor, Department of Gastroenterology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266003, Shandong Province, China. 18853288786@163.com
Received: September 21, 2021
Peer-review started: September 21, 2021
First decision: October 22, 2021
Revised: November 6, 2021
Accepted: January 22, 2021
Article in press: January 22, 2022
Published online: March 6, 2022
Processing time: 161 Days and 16.5 Hours
Abstract
BACKGROUND

Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell proliferative disorder that can progress to multiple myeloma (MM). Amyloidosis (light chain) (AL) is the most common form of systemic amyloidosis. There are few reports of SMM coexisting with AL involving the digestive tract.

CASE SUMMARY

A 63-year-old woman presented with lower limb edema, abdominal distension, abdominal pain, and hematochezia. Gastroscopy showed gastric retention, gastric angler mucosal coarseness, hyperemia, and mild oozing of blood. Colonoscopy showed hyperemic and edematous mucosa of the distal ascending colon and sigmoid colon with the presence of multiple round and irregular ulcers, submucosal ecchymosis, and hematoma. Gastric and colonic tissue biopsy confirmed the diagnosis of AL by positive Congo red staining. MM was confirmed by bone marrow biopsy and immunohistochemistry. The patient had no hypercalcemia, renal dysfunction, anemia, bone lesions or biomarkers of malignancy defined as plasma cells > 60% in bone marrow. Additionally, no elevated serum free light chain ratio, or presence of bone marrow lesions by magnetic resonance imaging (SLiM criteria) were detected. The patient was finally diagnosed with SMM coexisting with AL. She received chemotherapy and was discharged when the symptoms were relieved. She is doing well at nearly five years of follow up.

CONCLUSION

This case highlights that high index of suspicion is required to diagnose gastrointestinal AL. 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.

Keywords: Smoldering multiple myeloma; Multiple myeloma; Congo red staining; Gastrointestinal amyloidosis; Bone marrow biopsy; Endoscopic findings; Case report

Core Tip: We report an unusual case of smoldering multiple myeloma with gastrointestinal symptoms (abdominal distension, abdominal pain, and blood in the stool). Gastrointestinal amyloidosis (light chain) (AL) was suspected based on the endoscopic findings of granular-appearing mucosa, ecchymosis, and submucosal hematoma. The diagnosis of gastrointestinal AL was confirmed by Congo red staining of biopsied tissues. The patient was doing well at the last follow-up of 5 years after chemotherapy which is the best prognosis among the reported cases of multiple myeloma with gastrointestinal AL.