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Multiple Myeloma Presenting as Acute Liver Failure.

Stephanie Cull¹, David J Westrich¹, Ruchi Bhatia²

¹Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO.

ACG Case Reports Journal

|July 15, 2017

Summary

Multiple myeloma (MM) rarely causes liver failure. This case highlights MM presenting as acute liver injury, emphasizing its importance in differential diagnoses for liver decompensation.

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Area of Science:

Hematology
Hepatology
Oncology

Background:

Multiple myeloma (MM) is a plasma cell malignancy that rarely presents with liver failure.
Acute liver injury and decompensation typically have diverse etiologies, often excluding hematologic malignancies.

Observation:

A 79-year-old male presented with fatigue, anorexia, and signs of hepatic decompensation.
Liver biopsy revealed diffuse plasma cell infiltration, confirming hepatic involvement of MM.
Bone marrow biopsy confirmed the diagnosis of multiple myeloma.

Findings:

The patient's liver failure was attributed to extensive plasma cell infiltration from MM.
Despite initiating chemotherapy, the patient experienced rapid decompensation and succumbed to respiratory failure.
Hepatic MM at initial presentation was associated with a poor prognosis.

Implications:

Multiple myeloma should be included in the differential diagnosis for patients presenting with acute decompensated liver disease.
Early detection and prompt treatment of hepatic MM are crucial for potentially improving patient outcomes.
This case underscores the importance of considering rare causes of liver failure in clinical practice.