University of Massachusetts Medical School - Baystate Springfield, MA, United States
Kevin Groudan, MD, Kartikeya Tripathi, MD, Spencer Knox, MD, Jacob Alexander, MD, DM University of Massachusetts Medical School - Baystate, Springfield, MA
Introduction: Hypercalcemia from various etiologies is a known cause of acute pancreatitis, and primary hyperparathyroidism is the most common etiology. Hypercalcemia from multiple myeloma leading to acute pancreatitis is rare. We report a case of acute smoldering pancreatitis in a patient who was ultimately diagnosed with multiple myeloma causing hypercalcemia.
Case Description/Methods: A 74-year-old woman presented with acute epigastric pain radiating to her back and was found to have a lipase of 186 U/L and CT scan findings consistent with acute interstitial uncomplicated pancreatitis. Despite one week of management per acute pancreatitis protocol, she continued to have pain and difficulty tolerating oral intake. A repeat CT scan revealed moderate pancreatitis but no evidence of necrosis. Work up for etiology of pancreatitis was unrevealing. She was discharged once able to tolerate oral intake. A repeat CT scan with pancreatitis protocol was scheduled outpatient in 8 weeks along with gastroenterology follow up.
Outpatient CT scan revealed mild edematous pancreatitis along with a few small subcentimeter pseudocysts. At her follow up appointment, she continued to complain of epigastric postprandial pain, weight loss and difficulty tolerating solid food. Laboratory data obtained at that visit showed elevated total IgG levels and normal IgG4 levels. It also showed a corrected calcium level of 15.5 mg/dL. Endocrinology consultation was obtained, and hyperparathyroidism was ruled out. Hematology consultation was obtained, and she was then diagnosed with multiple myeloma and started on Lenalidomide for treatment.
Discussion: Pancreatitis secondary to hypercalcemia in the setting of multiple myeloma is rare. Typically, pancreatitis from hypercalcemia occurs when there is an acute rise in calcium; in patients with multiple myeloma, hypercalcemia is chronic. Our patient's calcium levels appropriately dropped during the acute phase of her pancreatitis when she was admitted to the hospital; however, her calcium levels were noted to be very high at her outpatient follow up, causing her persistent symptoms of smoldering pancreatitis. The possibility of underlying multiple myeloma in a patient with acute pancreatitis can be easily overlooked. Our case highlights that in patients with acute smoldering pancreatitis, underlying multiple myeloma must be considered in the differential along with other causes such as autoimmune pancreatitis, pancreatic mass, or other causes of chronic pancreatitis.
Disclosures: Kevin Groudan indicated no relevant financial relationships. Kartikeya Tripathi indicated no relevant financial relationships. Spencer Knox indicated no relevant financial relationships. Jacob Alexander indicated no relevant financial relationships.
Kevin Groudan, MD, Kartikeya Tripathi, MD, Spencer Knox, MD, Jacob Alexander, MD, DM. P1102 - Acute Pancreatitis Reveals an Underlying Multiple Myeloma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.