A case of multiple myeloma in a young woman with early manifestations of liver failure

Abstract

Multiple myeloma (MM) is a hematologic malignancy that is rarely found in younger patients. Manifestations of severe liver dysfunction, including liver failure, are infrequently reported and usually occur late in the course of MM. Early liver failure in such a young patient has not been previously reported. We report the case of a 38-year-old woman who presented with liver failure symptoms, including altered mental status, jaundice, elevated liver biochemical markers, and an elevated international normalised ratio (INR), without positive hepatitis virus markers or elevated procalcitonin. The patient underwent followup for MM due to recurrent anaemia with rouleaux formation on peripheral blood smear. Protein electrophoresis revealed monoclonal gammopathy, and
bone marrow puncture and biopsy findings were consistent with MM, with plasma cells representing 11% and 20-30% of the cell population, respectively. Chemotherapy with the VRD (bortezomib-lenalidomide-dexamethasone) regimen was then administered with close liver biomarker monitoring. After three cycles
of chemotherapy, the liver symptoms improved clinically and laboratory-wise. This condition suggests the possibility that MM is the culprit of the patient’s liver dysfunction. This case report also provides insight into the possibility of different clinical manifestations of MM in younger patients in Indonesia and is expected
to inform clinicians’ considerations when choosing management for MM with liver problems.