Metastatic multiple myeloma with hyperamylasaemia and hyperlipasaemia.

Accepted 10 March 1998 A 47-year-old non-alcoholic African-American woman was diagnosed to have multiple myeloma in December 1995. She received several cycles of chemotherapy with melphalan and prednisone. Initial days of chemotherapy were punctuated by recurrent hospital admissions for vomiting and abdominal discomfort, presumably due to chemotherapy. Serum amylase and lipase levels remained within normal limits during these admissions. Eighteen months after the initial diagnosis, she developed shortness of breath and left-sided chest pain. Serum lipase and amylase levels were normal. Computed tomography (CT) of the chest revealed a left intrathoracic pleural mass and bilateral effusions. Palliative radiotherapy was given to the left hemithorax, in addition to another cycle of chemotherapy. Six weeks later, the patient developed abdominal distension and vomiting. Physical examination revealed a toxic-looking woman with moderate ascites. Laboratory values on the day of admission were as follows: leucocytes 6.7 x 10/l, serum calcium 8.8 mg/dl (normal 8.5-10.5) serum lipase 114 IU/l (normal 4-24) and a serum amylase of 2306 IU/l (normal 44-128). A CT scan of the abdomen showed ascites with a large intra-abdominal mass on the left side. The pancreas was normal. Magnetic resonance imaging of the abdomen and pelvis supported CT scan findings. Abdominal sonogram was negative for gallstones. Ascitic fluid cytology revealed malignant plasma cells. Ascitic fluid amylase was 8500 IU/l.