Abstract:

This study reports a case of a 44-year-old female patient with multiple myeloma (MM). Her condition was initially relieved after treatment with bortezomib combined with dexamethasone. However, due to the patient's failure to adhere to the treatment schedule, the disease progressed. After switching to CD38 monoclonal antibody therapy, the di-sease again achieved remission. After 5 months of treatment, the patient suddenly experienced abdominal distension accompanied by cessation of anal gas and stool passage. Abdominal CT indicated intestinal obstruction. The patient underwent exploratory laparotomy, intestinal resection and anastomosis, and abdominal drainage. Postoperative T-cell spot test (T-SPOT) and pathological results confirmed the diagnosis of isolated intestinal tuberculosis complicated by incomplete intestinal obstruction. The patient received six months of quadruple anti-tuberculosis therapy (rifampicin 450 mg once daily orally, isoniazid 300 mg once daily orally, pyrazinamide 500 mg three times daily orally, streptomycin 750 mg once daily intramuscularly), after which her tuberculosis condition improved. However, due to the suspension of anti-tumor therapy, the MM progressed. The patient discontinued treatment for financial reasons and ultimately passed away 19 months after surgery due to MM progression. A review of relevant cases in the database shows that one patient who developed intestinal tuberculosis after heart transplantation was diagnosed with MM during anti-tuberculosis treatment, which later progressed to aggressive plasma cell leukemia. Although induction chemotherapy was administered, the patient experienced retroperitoneal hemorrhage and pancytopenia, and ultimately transitioned to palliative care. This case highlights that patients in an immunosuppressed state (such as MM) have a significantly increased risk of tuberculosis infection, among which extrapulmonary manifestations, such as intestinal tuberculosis, are relatively rare. Due to its atypical clinical manifestations, it is prone to being missed or misdiagnosed. Such infections may interfere with the course of antitumor therapy and affect patient prognosis. Clinicians should remain vigilant and strengthen differential diagnosis.

Key words: Multiple myeloma, Intestinal tuberculosis, Chemotherapy, Immunotherapy, Intestinal obstruction