Korean J Gastroenterol.  2020 Apr;75(4):220-224. 10.4166/kjg.2020.75.4.220.

Acute Pancreatitis with Hypercalcemia as Initial Manifestation of Multiple Myeloma

• Jo IH
• Paik CN

• KMID: 2504240
• DOI: http://doi.org/10.4166/kjg.2020.75.4.220

Abstract

A case of acute pancreatitis associated with hypercalcemia resulting from a newly diagnosed multiple myeloma is reported. There have been several prior reports of hypercalcemia-induced pancreatitis in patients with multiple myeloma, but very few showed the following two aspects: pancreatitis as the first manifestation of hematologic malignancy and recovery after serum calcium levels fell into normal range. When clinicians encounter a patient with hypercalcemic status and acute pancreatitis without any known etiology of pancreatitis, multiple myeloma as a root cause of pancreatitis should be considered.

Keyword

Pancreatitis; Hypercalcemia; Multiple myeloma

Figure

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  Fig. 1 Computed tomography scan of abdomen (non-enhanced). Mild edematous pancreatic parenchymal change with peripancreatic haziness.

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  Fig. 2 Skull X-ray image (lateral view). Multiple punched-out osteolytic lesions are scattered in numerous sizes (red arrow).

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  Fig. 3 (A) Serum electrophoresis showing an myeloma protein in the gamma region (black arrow). (B) Serum immunofixation demonstrates monoclonal bands on IgG and κ lanes, which is evidence of monoclonal gammopathy (IgG, κ type). ELP, electrophoresis; Ig, immunoglobulin; κ, kappa; L, lambda.

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  Fig. 4 (A) Microscopic finding of bone marrow shows that about 60% of nucleated elements are plasma cells, which are oval-shaped with a round eccentric nucleus and abundant basophilic cytoplasm (Giemsa stain, ×200). (B) Discrete plasma cell mass displaced normal marrow tissue, expressing CD138 on the immunohistochemical stain (CD138, ×100).

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  Fig. 5 Changes in serum calcium and amylase level during hospitalization. After hemodialysis, serum amylase levels decreased, as calcium levels had been normalized.

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