Published: 2020-09-24

Myeloma coexisting with jejunal light chain amyloidosis

Aishwarya K. Marimuthu, Purnima Ramkumar, Mohammed S. Abdulsalam, Prabu Pandurangan, Jainudeen Khalander Abdul Jameel, Maya Menon


Amyloid Light chain (AL) amyloidosis is a rare disease, which is seen in approximately one-tenth of patients with multiple myeloma. We report a 52 years old male, who presented with complaints of anorexia and weight loss. He was diagnosed to have multiple myeloma-international staging score (ISS) Stage 3 and was started on VTD (Bortezomib, Thalidomide, and Dexamethasone) chemotherapy. Within 2 weeks of therapy, he had abdominal symptoms like abdominal pain, loose stools, vomiting and hematochezia. Imaging showed dilated proximal bowel loops with fluid filled contents and prominent vessels in rectum. Emergency surgical exploration revealed thickened proximal jejunum with blood clots in the lumen. Resection of proximal jejunum was done. Histopathological examination of resected specimen was suggestive of AL amyloidosis. Post-surgical resection of jejunum, patient had initial improvement followed by deterioration. He was discharged against medical advice as per relative’s request. Hence an index of clinical suspicion of amyloidosis must been present in all Multiple myeloma patients.


Jejunal amyloidosis, Myeloma, Hematochezia

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Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med. 2003;349(6):583-96.

Picken MM. The Pathology of Amyloidosis in Classification: A Review. Acta Haematol. 2020; 1-13.

Theis JD, Dasari S, Vrana JA, Mereuta OM, Grogg KL, Gertz MA et al. Proteome Of Amyloidosis: Mayo Clinic Experience In 4139 Cases. Blood. 2013;122(21):1900.

Duhamel S, Mohty D, Magne J, Lavergne D, Bordessoule D, Aboyans V et al. Incidence and Prevalence of Light Chain Amyloidosis: A Population-Based Study. Blood 2017;30(1):5577.

Falk RH, Comenzo RL, Skinner M. The systemic amyloidoses. N Engl J Med. 1997;337(13):898-909.

Wechalekar AD, Gillmore JD, Hawkins PN. Systemic amyloidosis. Lancet. 2016;387(10038): 2641-54.

Kamal WS, Taib T, Noor NM, Jong TJ. Myeloma Associated Primary Systemic Amyloidosis. Ind J Dermato. 2016;61(1):124.

Rajkumar SV, Gertz MA, Kyle RA. Primary systemic amyloidosis with delayed progression to multiple myeloma. Cancer. 1998;82:1501-5.

Guidelines Working Group of UK Myeloma Forum; British Commitee for Standards in Haematology, British Society for Haematology. Guidelines on the diagnosis and management of AL amyloidosis. Br J Haematol. 2004;125(6):681-700.

Castillo JJ. Plasma Cell Disorders. Prim Care. 2016;43(4):677-91.

Alahdab F, Saligram S. Gastrointestinal amyloidosis and multiple myeloma. J Gen Intern Med. 2015; 30(2):261-6.

Ebert EC, Nagar M. Gastrointestinal manifestations of amyloidosis. Am J Gastroenterol. 2008;103:776-87.

Hokama A, Kishimoto K, Nakamoto M, Kobashigawa C, Hirata T, Kinjo N, et al. Endoscopic and histopathological features of gastrointestinal amyloidosis. World J Gastrointest Endosc. 2011;3(8):157.

Roccaro AM, Hideshima T, Raje N, Kumar S, Ishitsuka K, Yasui H, et al. Bortezomib mediates antiangiogenesis in multiple myeloma via direct and indirect effects on endothelial cells. Cancer Res. 2006;66(1):184-91.

Smith LC, Bertolotti P, Curran K, Jenkins B. IMF Nurse Leadership Board. Gastrointestinal side effects associated with novel therapies in patients with multiple myeloma: consensus statement of the IMF Nurse Leadership Board. Clin J Oncol Nurs. 2008;12(3):37-52.

Bhutani D, Lentzsch S. Diagnosis and management of systemic light chain AL amyloidosis. Pharmacol Ther. 2020;107612.

Sachchithanantham S, Offer M, Venner C, Mahmood SA, Foard D, Rannigan L, et al . Clinical profile and treatment outcome of older (> 75 years) patients with systemic AL amyloidosis. haemato. 2015 Nov 1;100(11):1469-76.