TY - JOUR T1 - Bleeding due to acquired dysfibrinogenemia as the initial presentation of multiple myeloma JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-229312 VL - 12 IS - 7 SP - e229312 AU - Namrah Siddiq AU - Colin Bergstrom AU - Larry D Anderson, Jr AU - Srikanth Nagalla Y1 - 2019/07/01 UR - http://casereports.bmj.com/content/12/7/e229312.abstract N2 - Patients with multiple myeloma (MM) are at risk for acquired dysfibrinogenemia resulting in laboratory abnormalities and/or bleeding complications. We describe a 63-year-old man who presented with bleeding diathesis in the presence of a low fibrinogen activity level with a normal fibrinogen antigen level. Further studies revealed elevated levels of lambda free light chains, and he was diagnosed with MM. Despite initiating treatment with bortezomib/dexamethasone, he continued to have recurrent bleeds along with hypofibrinogenaemia, prompting a switch to carfilzomib/dexamethasone. The patient responded with improvement in bleeding symptoms, normalisation of fibrinogen activity and a decrease in serum free light chains. ER -