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Massive arterial and venous thrombosis from smouldering multiple myeloma: further evidence for monoclonal gammopathy of thrombotic significance
  1. Jolie Kun1 and
  2. Jonathan Hunter1,2
  1. 1School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
  2. 2Internal Medicine, Redcliffe Hospital, Redcliffe, Queensland, Australia
  1. Correspondence to Dr Jonathan Hunter; Jonathan.Hunter{at}


A man in his 40s presented to the emergency department after 2 weeks of abdominal pain and bloating. Radiological investigations revealed multiple unusual sites of thrombosis, including large thrombi in his portal and mesenteric veins, and a left ventricular thrombus with resultant embolic infarcts to his spleen, kidneys, coronary arteries and brain. Standard causes of underlying thrombophilia were excluded. A serum protein electrophoresis and serum-free light chains, with subsequent bone marrow biopsy, lead to the diagnosis of smouldering multiple myeloma (sMM), albeit an unusual presentation with severe clinical sequelae. Although sMM is known to be associated with an increased risk of venous thromboembolism, it is not recognised to cause thrombosis in both venous and arterial vascular beds simultaneously. Physicians encountering patients with multiple thrombi in unusual vascular beds without clear aetiology should consider an underlying monoclonal gammopathy in their list of differentials.

  • Malignant and Benign haematology
  • Portal vein
  • Thrombosis
  • Heart failure

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  • Contributors JK was responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. JH gave final approval 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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