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Table 1 Relevant past medical history and interventions

From: Severe abdominal pain and diarrhea – unusual multiple myeloma presentation with a severe prognosis: a case report

Date Summaries from initial and follow-up visits Diagnostic testing Interventions
Day 1 Patient’s primary concerns were 3 days of diarrhea and generalized abdominal pain • Abdominal X-rays: generalized colon distension without obstruction signs
• Chest X-rays: pleural fluid in the left basal lung
• Chest CT scan: atelectasis in the left basal lung
• Neutrophilia
• Decreased albumin/globulin ratio
• Normal electrolytes
• Normal serum osmolality
• Normal stool test
In the emergency room:
• endogenous fluids
• antibiotics
• albumin
Day 2 We found a right lower quadrant mass on abdominal palpation.
Patient showed significant clinical improvement
• Abdominal CT with contrast: sigmoid diverticulosis and a 4.96 cm diameter right iliac crest mass
• Biopsy of the mass: plasmacytoma
• Thorax CT: severe lytic lesions
• Skeletal survey: multiple lytic lesions in the skull, femur, and humeral head
• Hyperproteinuria
• Alpha-2 monoclonal peak
• He was tolerating oral daily diet
• Diarrhea stopped
• Physical therapy
• Pulmonary-respiratory therapy with vibration and positive pressure exercises
Day 5 Clinically stable • Urine immunofixation came back positive for monoclonal gammopathy component type Kappa IgG
• Bone marrow biopsy: high expression of CD38 and CD56, compatible with a plasmatic cell neoplasia
• Multiple myeloma was confirmed
• Bortezomib was started
Day 12 Acute productive cough of white sputum • Thorax X-rays: pulmonary edema plus new costal fractures
• BNP was elevated to 307 pg/ml
• Hb was decreased to 10 mg/dl
• Transferred to intensive care unit
• Furosemide
• Erythropoietin
• Transfused with pack red blood cells
Day 17 Mental status progressively deteriorated.
Cardiorespiratory arrest
• BNP increased to 617.9 pg/ml
• Thorax X-rays: increased cardiac silhouette
• Do not resuscitate agreement with the family
  1. An 87-year-old Hispanic man with a family history including hypertension. Past medical history of hypertension, type 2 diabetes mellitus, and chronic constipation controlled with valsartan/amlodipine/insulin glargine. Non-tobacco smoker; occasionally drinks alcohol. BNP brain natriuretic peptide, CT computed tomography, Hb hemoglobin