eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2019-07-31 7 10 240 243 10.12691/ajmcr-7-10-5 AJMCR20197105 article Michael Haddadin 1 Mohammad Al-Sadawi 1 Sally Madanat 2 Eric Tam 3 Evelyn Taiwo 3 Carol Luhrs 3 Samy I Mcfarlane Samy.mcfarlane@downstate.edu 3 Department of internal Medicine, State University of New York-Downstate, Brooklyn, New York, USA Saint James School of Medicine St. Vincent, Cane Hall Road, Arnos Vale, St Vincent & the Grenadines Department of Hematology & Oncology, State University of New York-Downstate, Brooklyn, New York, USA Multiple Myeloma (MM) is a plasma cell disorder characterized by abnormal proliferation of plasma cells resulting in overproduction of paraprotein. Proteasome inhibitors (PI) have been a corner stone for the treatment of MM. Thrombotic Microangiopathy (TMA) is a recent hematological adverse event that has newly been recognized in multiple PI. TMA leads to end-organ damage and infarction by microthromobi. TMA pathophysiology is not well understood and has multiple etiologies. We present a case of PI-induced TMA, along with literature review of cases diagnosed from 2008-2018. Unique to our case is the onset of presentation, more than 24 months after initiating carfilzomib. Our case highlights the need for vigilant monitoring and the importance of clinical suspicion in patients at risk for TMA. http://pubs.sciepub.com/ajmcr/7/10/5/ajmcr-7-10-5.pdf carfilzomib thrombotic microangiopathy proteosome inhibitos