A RARE CASE PRESENTATION OF MULTIPLE MYELOMA AND HEPATIC ENCEPHALOPATHY IN A PATIENT WITH DECOMPENSATED CHRONIC LIVER DISEASE: A CASE REPORT
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Keywords
Multiple myeloma, hepatic encephalopathy, CRAB features, liver disease.
Abstract
Multiple myeloma rarely presents concurrently with hepatic encephalopathy, especially in patients with decompensated chronic liver disease (CLD). Overlapping biochemical abnormalities may delay diagnosis.
Case Presentation: A 76-year-old male presented with altered sensorium and hepatic encephalopathy. Laboratory findings showed renal dysfunction, hypercalcemia, anemia, reversed albumin-globulin ratio, and monoclonal protein, raising suspicion for multiple myeloma. Lytic bone lesions and bone marrow biopsy confirmed the diagnosis.1–3
Discussion: Hepatic encephalopathy generally reflects advanced CLD; however, co-existing plasma cell dyscrasias complicate the diagnostic picture. The presence of CRAB criteria—hypercalcemia, renal impairment, anemia, bone lesions—necessitates evaluation for myeloma, even in CLD patients.4–10
Conclusion: Plasma cell dyscrasias should be considered in CLD patients who present with unexplained metabolic derangements.
References
2Kyle RA, Durie BGM, Rajkumar SV, et al. MGUS and smoldering myeloma. Leukemia.2010;24(6):1121–7.
3Kumar SK, Rajkumar V, Kyle RA, et al. Multiple myeloma. Nat Rev Dis Primers. 2017;3:17046.
4EASL Clinical Practice Guidelines: Hepatic encephalopathy. J Hepatol. 2022;77(3):827–44.
5Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011;364:1046–60.
6Rajkumar SV, Dimopoulos MA, Palumbo A, et al. IMWG diagnostic criteria. Lancet Oncol.2014;15:e538–48.
7Bird JM, Owen RG, D’Sa S, et al. Guidelines for multiple myeloma. Br J Haematol.2011;154(1):32–75.
8Dimopoulos MA, Terpos E, et al. Renal impairment in myeloma. Leukemia. 2010;24:525–34.
9Schreiber YS, Schafer DF. Hepatic encephalopathy. World J Gastroenterol. 2015;21:11523–35.
10Ludwig H, Sonneveld P, et al. Myeloma complications. Haematologica. 2018;103:1866–77.
11Tapper EB, Sharma P. Liver disease in elderly. Clin Geriatr Med. 2020;36:277–88.
12Chim CS, Kumar SK, et al. Relapsed myeloma. Leukemia. 2018;32:252–62.
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Dr Rishabh Ahlawat
( MBBS , junior resident , Department of General medicine ), Sharda University,
Dr Deepak Sharma
(MBBS , MD , DM(NEPHROLOGY), FIMSA) Professor And Head , Department Of General Medicine , Sharda University
Dr Vinay Mathur
( MBBS , junior resident , Department of General medicine ), Sharda University,
Dr Saket Kanodia
( MBBS , junior resident , Department of General medicine ), Sharda University,
Dr Rudra Dutt Kaushik
(MBBS , junior resident , Department of General medicine), Sharda University,
Dr Deepak Singla
( MBBS , junior resident , Department of General medicine ), Sharda University,
