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Case report
Extramedullary relapse in a patient with multiple myeloma: a rare cause of gastrointestinal perforation and massive bleeding
  1. Christoffer Galletta Rene1,
  2. Michael Patrick Achiam1,
  3. Morten Salomo2 and
  4. Luit Penninga1
  1. 1Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
  2. 2Department of Haematology, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Luit Penninga; LP{at}ctu.dk

Abstract

Multiple myeloma (MM) patients live longer due to more effective treatment, and we now see previously uncommon manifestations of MM, like extramedullary disease. We present a case of a 74-year-old man known with MM that relapsed with extramedullary manifestations at different locations. One of them as a gastric plasmacytoma (GP). He was successfully treated with chemoradiotherapy (Daratumumab, Bortezomib and Dexamethasone), which resulted in clinical response for 8 months, confirmed by biopsy and histopathology. Perforation of the GP occurred, and he underwent partial gastrectomy (Billroth II gastrojejunostomy). The patient’s disease progressed again 5 months after surgery, and he did not want any additional treatment. He accepted palliative care and died 10 months after the operation. A lack of knowledge about the characteristics and treatment of extramedullary MM exists, and prospective studies to investigate incidence, prognosis and treatment for extramedullary MM are needed for improving the poor prognosis of this manifestation.

  • ulcer
  • haematology (incl blood transfusion)
  • gastrointestinal surgery
  • general surgery

http://dx.doi.org/10.1136/bcr-2021-243663

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    Footnotes

    • Contributors All editors have contributed sufficiently to the manuscript. LP and MA had the idea. CR collected the data and prepared the manuscript. LP, MS, MA critically revised the manuscript. All authors accepted the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.