[Neutropenic enteropathy associated with multiple myeloma]

Area of Science:

• Gastroenterology
• Hematology
• Oncology

Background:

• Neutropenic enteropathy (NE) is an acute intestinal condition often linked to chemotherapy in pediatric leukemias and lymphomas.
• Less common causes include neutropenia in adults due to autoimmune diseases, aplastic anemia, cyclic neutropenia, or solid tumors.
• Multiple myeloma (MM) is an uncommon but serious association with NE.

Observation:

• A 62-year-old male with a history of MM diagnosed 10 months prior, undergoing chemotherapy, presented with severe abdominal pain, nausea, vomiting, diarrhea, and rectal bleeding.
• Autopsy revealed extensive colonic ulcers and thickening (40% surface area) and ileal involvement (5%).
• Microscopic examination showed ischemic necrosis of the mucosa and submucosa with bacterial invasion and a lack of acute inflammatory response.

Findings:

• This case represents the third documented instance of NE associated with MM.
• The patient had received vincristine and steroids shortly before developing neutropenia, consistent with previous reports.
• This report provides clinical and morphological details of NE in an MM patient, being the first illustrated case from Mexico.

Implications:

• This case underscores the aggressive clinical behavior of NE, even in the context of multiple myeloma.
• It highlights the importance of considering NE in neutropenic patients with gastrointestinal symptoms, particularly those with hematological malignancies.
• Further research into the specific mechanisms and management of NE in MM patients is warranted.