Intest Res.  2017 Apr;15(2):249-254. 10.5217/ir.2017.15.2.249.

Crohn's disease and smoldering multiple myeloma: a case report and literature review

Affiliations
  • 1Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul, Korea.
  • 3Division of Medical Oncology and Hematology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea. mchihoon@khu.ac.kr
  • 4Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

Abstract

Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that presents with abdominal pain, weight loss, and diarrhea. Although the etiology has not been fully elucidated, both environmental and genetic causes are known to be involved. In chronic inflammatory conditions such as IBD, B lymphocytes are chronically stimulated, and they induce monoclonal expansion of plasma cells, sometimes resulting in monoclonal gammopathy of undetermined significance. Immunomodulators that are commonly used to control inflammation, such as tumor necrosis factor-α (TNF-α) blockers could increase the possibility of hematologic malignancy. The pathogenesis of multiple myeloma in association with TNF-α inhibitor therapy is attributed to decreased apoptosis of plasma cell populations. Here, we describe a case of a 36-year-old male patient who was diagnosed with immunoglobulin A subtype smoldering multiple myeloma during the treatment for CD with infliximab and adalimumab. We report this case along with a review of the literature on cases of multiple myeloma that occurred in conjunction with CD.

Keyword

Crohn disease; Multiple myeloma; Tumor necrosis factor-alpha

MeSH Terms

Abdominal Pain
Adalimumab
Adult
Apoptosis
B-Lymphocytes
Crohn Disease*
Diarrhea
Hematologic Neoplasms
Humans
Immunoglobulin A
Immunologic Factors
Inflammation
Inflammatory Bowel Diseases
Infliximab
Male
Monoclonal Gammopathy of Undetermined Significance
Multiple Myeloma*
Necrosis
Plasma Cells
Tumor Necrosis Factor-alpha
Weight Loss
Adalimumab
Immunoglobulin A
Immunologic Factors
Infliximab
Tumor Necrosis Factor-alpha

Figure

  • Fig. 1 Serum protein electrophoresis and immunofixation. (A) Serum protein electrophoresis. It shows abnormal zone of restriction in β-2 region. The β-2 globulin region represented 13.1% of total proteins (7.40 g/dL). This finding is suggestive of monoclonal gammopathy. The amount of M-peak is estimated to b 0.48 g/dL (white arrow). (B) Serum immunofixation electrophoresis. Serum immunotyping shows abnormal zone of restriction in IgA and κ type.

  • Fig. 2 Peripheral blood smear and bone marrow study. (A) Peripheral blood smear exhibiting marked rouleaux formation (white arrows) (Wright-Giemsa stain, ×1,000). (B) Bone marrow aspirate. Plasma cells accounted for 14.0% of the cell count (H&E, ×200). (C) Bone marrow aspirate. Plasma cells accounted for 14.0% of the cell count (black arrows) (H&E, ×1,000).

  • Fig. 3 Timeline (in years) showing CD diagnosis, CD treatment, and diagnosis of smoldering multiple myeloma. No records are available for cases before 2010.


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