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A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome

Autoimmune events are rare in multiple myeloma (MM). Herein, we report a rare case of a patient presenting with recurrent gastrointestinal (GI) bleeding of unknown origin, also having pancytopenia eventually diagnosed as MM with Evans syndrome. This is an uncommon disorder presenting as autoimmune h...

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Autores principales: Khan, Muhammad S, Kasmani, Rahil, Khan, Ghazal, Changal, Khalid, Singh, Hemindermeet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867356/
https://www.ncbi.nlm.nih.gov/pubmed/31777698
http://dx.doi.org/10.7759/cureus.5969
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author Khan, Muhammad S
Kasmani, Rahil
Khan, Ghazal
Changal, Khalid
Singh, Hemindermeet
author_facet Khan, Muhammad S
Kasmani, Rahil
Khan, Ghazal
Changal, Khalid
Singh, Hemindermeet
author_sort Khan, Muhammad S
collection PubMed
description Autoimmune events are rare in multiple myeloma (MM). Herein, we report a rare case of a patient presenting with recurrent gastrointestinal (GI) bleeding of unknown origin, also having pancytopenia eventually diagnosed as MM with Evans syndrome. This is an uncommon disorder presenting as autoimmune hemolytic anemia (AIHA) with immune thrombocytopenia purpura (ITP). A 56-year-old African American male presenting with recurrent GI bleeds and pancytopenia of unknown origin developed acute colonic diverticulitis on recurrent admissions, and sigmoid colectomy with primary anastomosis was performed. Flow cytometry with serum protein electrophoresis eventually revealed IgG MM with elevated Kappa/Lambda ratio. Bone marrow biopsy revealed 80% to 90% Kappa clonal plasma cells confirming MM. Direct antiglobulin test (DAT) was positive with pancytopenia. The patient initially showed a good response to chemotherapy with thrombocytopenia improving with intravenous (I/V) dexamethasone. DAT done after completion of initial chemotherapy was negative. However, his disease relapsed after three months with pancytopenia and DAT becoming positive again. The patient was restarted on chemotherapy for debulking, which resulted in a negative DAT again after two months, but pancytopenia did not improve. The patient eventually passed away due to subarachnoid hemorrhage. We highlight only this fourth reported case because of its unique presentation. In elderly patients with unknown cause of GI bleeding with pancytopenia, blood dyscrasias, especially MM, should be considered. Autoimmune workup if positive might warrant the use of steroids for pancytopenia, which can improve thrombocytopenia in MM with Evans syndrome but not anemia. 
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spelling pubmed-68673562019-11-27 A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome Khan, Muhammad S Kasmani, Rahil Khan, Ghazal Changal, Khalid Singh, Hemindermeet Cureus Oncology Autoimmune events are rare in multiple myeloma (MM). Herein, we report a rare case of a patient presenting with recurrent gastrointestinal (GI) bleeding of unknown origin, also having pancytopenia eventually diagnosed as MM with Evans syndrome. This is an uncommon disorder presenting as autoimmune hemolytic anemia (AIHA) with immune thrombocytopenia purpura (ITP). A 56-year-old African American male presenting with recurrent GI bleeds and pancytopenia of unknown origin developed acute colonic diverticulitis on recurrent admissions, and sigmoid colectomy with primary anastomosis was performed. Flow cytometry with serum protein electrophoresis eventually revealed IgG MM with elevated Kappa/Lambda ratio. Bone marrow biopsy revealed 80% to 90% Kappa clonal plasma cells confirming MM. Direct antiglobulin test (DAT) was positive with pancytopenia. The patient initially showed a good response to chemotherapy with thrombocytopenia improving with intravenous (I/V) dexamethasone. DAT done after completion of initial chemotherapy was negative. However, his disease relapsed after three months with pancytopenia and DAT becoming positive again. The patient was restarted on chemotherapy for debulking, which resulted in a negative DAT again after two months, but pancytopenia did not improve. The patient eventually passed away due to subarachnoid hemorrhage. We highlight only this fourth reported case because of its unique presentation. In elderly patients with unknown cause of GI bleeding with pancytopenia, blood dyscrasias, especially MM, should be considered. Autoimmune workup if positive might warrant the use of steroids for pancytopenia, which can improve thrombocytopenia in MM with Evans syndrome but not anemia.  Cureus 2019-10-22 /pmc/articles/PMC6867356/ /pubmed/31777698 http://dx.doi.org/10.7759/cureus.5969 Text en Copyright © 2019, Khan et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Oncology
Khan, Muhammad S
Kasmani, Rahil
Khan, Ghazal
Changal, Khalid
Singh, Hemindermeet
A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome
title A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome
title_full A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome
title_fullStr A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome
title_full_unstemmed A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome
title_short A Case of Multiple Myeloma Presenting with Gastrointestinal Bleeding and Evans Syndrome
title_sort case of multiple myeloma presenting with gastrointestinal bleeding and evans syndrome
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867356/
https://www.ncbi.nlm.nih.gov/pubmed/31777698
http://dx.doi.org/10.7759/cureus.5969
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