An Abnormal Presentation of Multiple Myeloma in Pregnancy: A Case Report

Multiple myeloma (MM) is an uncommon hematologic malignancy in the general population and extremely rare in pregnant and peripartum women. Here we report a rare case of multiple myeloma in a 43-year-old African American woman at 24 weeks gestation who presented for severe flank pain and difficulty breathing. An elevated D-dimer was present on initial presentation and diagnoses of deep vein thrombosis and pulmonary embolism were ruled out via bilateral Doppler ultrasounds and CT scan. Lytic bone lesions, anemia, and elevated total protein were also noted and an iliac crest biopsy demonstrating monoclonal plasma cells confirmed the diagnosis of MM. She was started on steroids at 27 weeks gestation and delivered via c-section at 30 weeks gestation. Postpartum, a treatment regimen to allow for breastfeeding was discussed but was unable to be accommodated, and she was started on a multi-drug chemotherapy regimen. There have only been about 30 cases of multiple myeloma in pregnant women reported in the literature. The rarity and lack of information on the effects of multiple myeloma in pregnancy was the primary indication for publication of this case.