A rare association: celiac disease and multiple myeloma in an asymptomatic young patient

Abstract

Celiac Disease (CD) is a gluten-sensitive enteropathy, and an autoimmune disorder involving an innate and adaptive immune response that occurs in genetically predisposed patients who are exposed to gluten-containing foods and other environmental factors. Early diagnosis and treatment are essential in preventing complications of the disease. Symptoms may appear both in childhood or adulthood by the ingestion of gluten and are usually characterized by gastrointestinal symptoms

however, the diagnosis may be delayed because of various extraintestinal manifestations, such as iron deficiency anemia, osteoporosis, or non-specific skin lesions in adult patients. Although CD has been shown to have an increased risk of all malignancies, plasma dyscrasias, especially multiple myeloma (MM) associations, are rare and reported to be seen in elderly patients. The current report presents a 42-year-old female patient with a recent dysphagia after a hot food ingestion with no other complaints. Laboratory investigations revealed a mild anemia and high serum protein levels. CD was diagnosed after a small bowel biopsy and MM was diagnosed after a serum protein electrophoresis with immunotyping studies (IgA lambda as the monoclonal protein) and bone marrow biopsy. In the laboratory, Immunotyping studies of monoclonal protein included two alternative methods

Immunofixation electrophoresis and immunosubtraction method with capillary electrophoresis. Our patient, is young to have MM, since the median age at diagnosis of MM is 66 years and only 2\% of patients are younger than 50 years. We believe that celiac disease played a significant role in the development of MM in this particular patient with IgA monoclonality and conclude that CD patients, even if they are young, must be monitored for plasma dyscrasias in addition to other malignancies.