Multiple myeloma presenting as acute pancreatitis.

Area of Science:

• Internal Medicine
• Oncology
• Gastroenterology

Background:

• Multiple myeloma (MM) is a plasma cell malignancy typically affecting older adults (>60 years).
• Classic MM symptoms include anemia, bone pain, and elevated erythrocyte sedimentation rate.
• Hypercalcemia is a known complication of MM, but acute pancreatitis is an infrequent manifestation.

Observation:

• A 36-year-old male presented with severe epigastric pain, nausea, vomiting, diarrhea, anorexia, respiratory distress, shock, and fever.
• Initial diagnosis was acute pancreatitis with hypercalcemia, thrombocytopenia, and elevated creatinine.
• Abdominal CT revealed lytic bone lesions and pancreatic necrosis, prompting further investigation.

Findings:

• Bone marrow biopsy confirmed multiple myeloma.
• This case represents an atypical presentation of multiple myeloma in a significantly younger patient.
• The patient's presentation mimicked severe acute pancreatitis, obscuring the underlying malignancy initially.

Implications:

• This case emphasizes the need to consider multiple myeloma in younger patients presenting with unexplained acute pancreatitis, especially when accompanied by hypercalcemia and bone lesions.
• It expands the spectrum of clinical presentations for multiple myeloma.
• Early recognition of rare MM manifestations is crucial for timely diagnosis and management, even in atypical demographics.