American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
American Journal of Medical Case Reports. 2015, 3(8), 244-246
DOI: 10.12691/ajmcr-3-8-6
Open AccessCase Report

Pulmonary Embolism: A Rare Initial Manifestation of Multiple Myeloma

Parijat Sen1, Abhishek Kumar2, Mary Mathews3, , Daphne Macbruce4 and Richard Miller4

1Department of Internal Medicine, St. Michael’s Medical Center, Newark, USA

2Department of Hematology and Oncology, St. Joseph’s Regional Medical Center, New Jersey, USA

3Department of Internal Medicine, St. Joseph’s Regional Medical Center, New Jersey, USA

4Department of Pulmonary Medicine, St. Michael’s Medical Center, Newark, USA

Pub. Date: July 02, 2015

Cite this paper:
Parijat Sen, Abhishek Kumar, Mary Mathews, Daphne Macbruce and Richard Miller. Pulmonary Embolism: A Rare Initial Manifestation of Multiple Myeloma. American Journal of Medical Case Reports. 2015; 3(8):244-246. doi: 10.12691/ajmcr-3-8-6


Multiple Myeloma usually presents with end organ damage like bone symptoms such as pain, pathologic fracture, renal dysfunction, chronic fatigue from anemia or symptoms of hypercalcemia. Although frequently associated with venous thromboembolisms, the presentation of multiple myeloma with pulmonary embolism as its initial manifestation is extremely rare. We report the case of a 60 y/o Hispanic male who presented with a Pulmonary Embolism, further diagnostic test revealed an underlying diagnosis of Multiple Myeloma.

pulmonary embolism multiple myeloma initial manifestation

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 1


[1]  Kyle R.A, Rajkumar SV. Multiple Myeloma. Blood. 2008 Mar 15; 111(6): 2962-2972.
[2]  Lokhorst HM, Sonneveld P, Cornelissen JJ, Joosten P, van Marwijk Kooy M, Meinema J, et al. Induction therapy with vincristine, adriamycin, dexamethasone (VAD) and intermediate-dose melphalan (IDM) followed by autologous or allogeneic stem cell transplantation in newly diagnosed multiple myeloma. Bone Marrow Transplant. 1999 Feb. 23(4):317-22.
[3]  Danylesko I, Beider K, Shimoni A, Nagler A. Novel Strategies for Immunotherapy in Multiple Myeloma: Previous Experience and Future Directions. Clin Dev Immunol. 2012; 2012: 753407.
[4]  Richardson PG, Barlogie B, Berenson J, Singhal S, Jagannath S, Irwin D, et al. A phase 2 study of bortezomib in relapsed, refractory myeloma. N Engl J Med. 2003 Jun 26. 348(26):2609-17.
[5]  Khorana AA. Malignancy, thrombosis and Trousseau: the case for an eponym. J Thromb Haemost. 2003 Dec;1(12):2463-5.
[6]  Levitan N1, Dowlati A, Remick SC, Tahsildar HI, Sivinski LD, Beyth R, Rimm AA. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those withoutmalignancy. Risk analysis using Medicare claims data. Medicine (Baltimore). 1999 Sep; 78(5):285-91.
[7]  Palumbo A, Palladino C. Venous and arterial thrombotic risks with thalidomide: evidence and practical guidance. Ther Adv Drug Saf. 2012 Oct; 3(5): 255-266.
[8]  Sakuma M, Fukui S, Nakamura M, Takahashi T, Kitamukai O, Yazu T, et al. Cancer and pulmonary embolism: thrombotic embolism, tumor embolism, and tumor invasion into a large vein. Circ J 2006; 70:744-749.
[9]  Castelli R, Ferrari B, Cortelezzi Aet al. Thromboembolic complications in malignant haematological disorders. CurrVascPharmacol 2010 Jul;8(4): 482-94.
[10]  Zangari M1, Saghafifar F, Mehta P, Barlogie B, Fink L, Tricot G.The blood coagulation mechanism in multiple myeloma. Semin Thromb Hemost. 2003 Jun; 29(3):275-82.
[11]  Cavo M, Zamagni E, Cellini C, et al. Deep vein thrombosis in patients with multiple myeloma receiving first-line thalidomide dexamethasone therapy. Blood 2002; 100: 2272-3.
[12]  Isozumi Y, Arai R, Fujimoto K, Koyama T. Activation of Coagulation by Lenalidomide-Based Regimens for the Treatment of Multiple Myeloma. PLoS One. 2013; 8(5): e64369.
[13]  Barlogie B1, Desikan R, Eddlemon P, Spencer T, Zeldis J, Munshi N, Badros A, Zangari M, Anaissie E, Epstein J, Shaughnessy J, Ayers D, Spoon D, Tricot G.Extended survival in advanced and refractory multiple myeloma after single-agent thalidomide: identification of prognostic factors in a phase 2 study of 169 patients. Blood. 2001 Jul 15; 98(2):492-4.
[14]  Facon T1, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B, Renaud M, Harousseau JL, Guillerm G, Chaleteix C, Dib M, Voillat L, Maisonneuve H, Troncy J, Dorvaux V, Monconduit M, Martin C, Casassus P, Jaubert J, Jardel H, Doyen C, Kolb B, Anglaret B, Grosbois B, Yakoub-Agha I, Mathiot C, Avet-Loiseau H;Intergroupe Francophone du MyélomeMelphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensityautologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet. 2007 Oct 6; 370(9594): 1209-18.
[15]  Zangari M1, Siegel E, Barlogie B, Anaissie E, Saghafifar F, Fassas A, Morris C, Fink L, Tricot G.Thrombogenic activity of doxorubicin in myeloma patients receiving thalidomide: implications for therapy. Blood. 2002 Aug 15; 100(4):1168-71.
[16]  Vallianou N1, Lazarou V, Tzangarakis J, Barounis R, Sioula E. Pulmonary embolism as the first manifestation of multiple myeloma. Case Rep Med. 2013; 2013: 236913.