A rare case report of multiple myeloma presenting with paralytic ileus and type II respiratory failure due to hypercalcemic crisis

Abstract

Rationale: Paralytic ileus is characterized by the signs and symptoms of intestinal obstruction but without any mechanical lesions in the intestinal lumen. Several medical and surgical conditions can lead to this ailment, such as electrolyte disturbances that impair intestinal motility. However, hypercalcemia secondary to multiple myeloma as a major cause of paralytic ileus has rarely been reported.

Patient concerns: The patient got severe constipation with difficulty in the passage of both gas and feces for 7 days.

Diagnoses: The patient was diagnosed with a small intestinal obstruction initially and then developed type II respiratory failure. Investigations revealed hypercalcemic crisis, and examination of a bone marrow aspirate was consistent with multiple myeloma.

Interventions: Conservative treatment was administered for the intestinal obstruction, consisting of food and water deprivation, gastrointestinal decompression, colonic irrigation, intravenous fluid transfusion, anti-inflammatory therapy. Invasive respiratory support was provided after type II respiratory failure occurred and salmon calcitonin was used to reduce the blood calcium level. Further therapy was given by the Department of Hematology and Oncology in our hospital after the diagnosis of multiple myeloma.

Outcomes: Spontaneous respiration and gastrointestinal function were restored after the correction of hypercalcemia.

Lessons: An appropriate diagnostic approach is needed in emergency practice to identify the paralytic ileus and type II respiratory failure caused by hypercalcemia secondary to multiple myeloma.

Figure 1

Computed tomography scan reveals small intestinal obstruction. No obvious mechanical obstruction is found on CT scanning. The small intestine is generally dilated, and air–fluid levels can be seen in the intestine. CT = computed tomography

Figure 2

Bone marrow needle biopsy confirms a diagnosis of multiple myeloma. The oncocytes are immature and poorly differentiated plasmocytes. Vacuole can be seen in the nuclei of the oncocytes, and slight chromatin loosening is present.

Figure 3

Flow cytometric immunophenotyping of bone marrow indicates that P6 cells (expressing CD38, CD138, CXCR4, CD200, and cLambda^dim and not CD7, CD117, CD56, CD34, CD19, CD20, CD10, CD22, CD27, CD28, CD13, CD33, and cκ) make up 16.89% of karyocytes; that is, 16.89% of the sample cells are abnormal monoclonal plasma cells. APC = allophycocyanin, CD = cluster of differentiation, CT = computed tomography, Cy = cyanine, FITC-A = fluorescein isothiocyanate - area, PE-A = phycoerythrin - area, PI = propidium iodide, SSC = side scatter.