Hyperammonemic Encephalopathy: A Unique Presentation of Multiple Myeloma

Area of Science:

• Hematology
• Neurology
• Oncology

Background:

• Multiple myeloma, a plasma cell malignancy, presents diverse symptoms and affects multiple organ systems.
• The complete pathophysiology of multiple myeloma remains incompletely understood.
• This case involves a 51-year-old male with a history of treated multiple myeloma in remission.

Observation:

• The patient initially presented with chest pain and unremarkable diagnostic work-up.
• His condition deteriorated due to hyperammonemia, leading to encephalopathy and mechanical ventilation.
• An extensive investigation ultimately diagnosed relapsing multiple myeloma as the underlying cause.

Findings:

• Multiple myeloma can manifest as hyperammonemic encephalopathy, a rare but severe complication.
• This condition carries a high rate of morbidity and mortality.
• The patient's prolonged hospital course led to the decision for comfort measures, and he subsequently passed away.

Implications:

• Hyperammonemic encephalopathy due to multiple myeloma should be considered in differential diagnoses for hyperammonemia.
• Early and aggressive treatment may improve patient outcomes.
• Further research is crucial to enhance understanding and reduce mortality associated with this manifestation.