An atypical initial manifestation of IgD myeloma

A 52-year-old man presented with a 3-day history of abdominal pain and hematochezia in the context of 6 months of recurrent oral ulcers and petechiae around his eyes. Physical examination revealed petechiae around the left eye and multiple ulcerative lesions on the tongue (Figure 1A and 1B). His abdomen was soft with slight tenderness. Laboratory investigations revealed mild hypoalbuminemia (35.2 g/L) and a significant decrease in immunoglobulin level (13.6 g/L). Notably, the blood routine test and biochemical studies on admission were normal. Gastrointestinal endoscopy was negative except for fresh blood observed in the cecum. Abdominal CT revealed diffuse intestine wall thickening and the presence of intraperitoneal effusion (Figure 1C, arrows).