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Dig Dis Sci (2007) 52:18511854 DOI 10.1007/s10620-006-9157-6
ORIGINAL PAPER
Multiple Myeloma Presenting with Malabsorption
H. Cardoso A. Sousa Machado P. Figueira A. Vasconcelos Teixeira F. Tavarela Veloso J. M. Lopes
Received: 16 September 2005 / Accepted: 14 November 2005 / Published online: 6 April 2007
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Springer Science+Business Media, Inc. 2007
Introduction
Segmental involvement of the gastrointestinal tract in multiple myeloma has been reported very rarely [17]. The clinical case of a 68-year-old man who had chronic diarrhea and severe weight loss is reported. Videocapsule endoscopy showed diffuse involvement of the whole small bowel mucosa with enlarged white villosities. Duodenal biopsy revealed expansion of villosities by macrophage inltration, lymph vessels ectasia, and proteinaceous material deposits. To the best of our knowledge, diffuse involvement of the whole small bowel in multiple myeloma has never been described.
Case report
A 68-year-old Caucasian man, a farmer, developed anorexia and diarrhea of watery stools that gradually worsened over 1 year. He had had progressive weight loss of 24 kg over 6 months, associated with fatigue and frequent lumbar pain when he was hospitalized for study. Physical examination revealed mild pallor, muscular atrophy, and peripheral edema. The abdominal exam was normal and no lymphadenopathies were found.
Laboratory studies revealed anaemia (haemoglobin8.8 g/dL <13), thrombocytopenia (platelets 71 109/L <180), hypoproteinemia (52 g/L <64), increased levels of aspartate aminotransferase (96 U/L >31) and alanine amino-transferase (100 U/L >31), decreased levels of cholesterol
H. Cardoso A. S. Machado P. Figueira A. V. Teixeira F. T. Veloso J. M. Lopes Department of Gastroenterology, Hospital So Joo, Faculty of Medicine of Porto, Portugal
(0.02 g/L <1.2) and triglycerides (0.03 g/L <0.75), increased serum levels of creatinine (25.9 mg/L >13), hypocalcaemia (3.7 mEq/L <4) and increased partial thromboplastin(42.5 > 36.5) and prothrombin times (14.5 > 13.1). Protein electrophoresis showed a monoclonal band in gamma globulin. Serum bilirubin, alkaline phosphatase, -glutamyl transferase, glucose, amylase, serum electrolytes, iron, folic acid, B12 vitamin and C-reactive protein were all within normal limits. Microbiologic and parasitologic analysis of the stools was negative. Hepatitis B virus, hepatitis C virus and human immunodeciency virus markers and antinu-clear, anti-smooth muscle, anti-mitochondrial, anti-gliadin and anti-transglutaminase antibodies were negative. Serum 1-antitrypsin and -fetoprotein were normal.
Abdominal ultrasonography revealed hepatic steatosis. Echocardiogram was normal. Computed tomography...