Gut and Gastroenterology


Hyperbilirubinemia an Atypical Presentation of Multiple Myeloma

Author(s): Sohal Aalam, Sandhu Sunny, Gill Amitpaul, Roytman Marina

Multiple Myeloma (MM) is a plasma cell malignancy commonly diagnosed in patients over 60. The most common presentations of MM include back pain, fatigue, weight loss, and renal dysfunction. Jaundice, as the initial presentation has rarely been reported. Literature review revealed several cases reporting this unusual presentation and their presumed pathophysiologic mechanisms.
Jaundice in MM can result from pre-hepatic, intra-hepatic, or post-hepatic causes. Autoimmune hemolytic anemia (AIHA) is an example of a pre-hepatic cause. Intra-hepatic causes include hepatic deposition of amyloid or light chains, infiltration of plasma cells, or inflammation due to increased cytokine activity. Post-hepatic processes are most commonly the result of bile duct obstruction by pancreatic plasmacytomas. 
In this review, we discuss the various pathophysiologic mechanisms that can lead to jaundice in MM. The aim is to broaden the differential diagnosis of jaundice, especially in an elderly patient with no underlying liver disease. 
Timely identification of MM as the cause of jaundice is critical as prompt diagnosis and treatment of underlying MM result in more favourable outcomes.

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