Multiple Myeloma Associated Intestinal Amyloidosis: Intestinal Pseudoobstruction Falsely Considered as an Ascites

Introduction: Amyloidosis is a group of diseases pathohistologically diagnosed by characteristic extracellular deposition of an abnormal fibrillary protein (i.e. amyloid) into organs, leading to organ dysfunction secondary to destruction of normal tissue architecture.

Methods: Case-report of a 44 year-old female, presenting with massive abdominal distension clinically suspected of ascites.

Results: On admission, the patient was complaining of nausea, vomiting, abdominal pain, distension and bloating associated with weight loss and diarrhoea. Her prior medical history revealed a treatment naïve viral hepatitis C (HCV) infection with normal liver tests. She was on long term haemodialysis due to end-stage renal disease. Based on clinical, laboratory and radiology findings we established the diagnosis of light chain amyloidosis associated with multiple myeloma, complicated with amyloid bowel depositions and intestinal pseudo-obstruction. On imaging, diffuse liver enlargement was seen. Liver biopsy could have rendered the possible cause of hepatomegaly, but patient's noncompliance hindered the answer whether liver involvement was the consequence of a chronic hepatitis due to HCV infection or amyloid accumulation. Unfortunately, consequent patient's death prevented specific treatment implementation.

Conclusion: Patients with multiple myeloma and obscure abdominal complaints should be worked up for amyloidosis. Intestinal pseudo-obstruction due to amyloidosis can imitate in certain instances ascites hence complicating diagnostic algorithm. In such complex clinical cases, close collaboration between surgeon, gastroenterohepatologist and haematologist is necessary.