title: Multiple myeloma presenting with a fever of unknown origin and development of thrombotic thrombocytopenic purpura post-bortezomib.
abstract: Multiple myeloma rarely presents with a fever of unknown origin and diagnosis may be delayed. We describe a case of myeloma presenting in this way with raised serum-free light chains and TP53 deletion on cytogenetics. The patient developed thrombotic thrombocytopenia purpura (TTP) following bortezomib therapy but recovered spontaneously and was successfully re-challenged. We believe this is only the second case to describe this phenomenon post-bortezomib and the first to rechallenge the patient successfully without further recurrence of TTP. Possible mechanisms for this successful rechallenge are discussed.
authors.affiliation: Department of Haematology, Wellington Hospital, Wellington, New Zealand.
authors.forename: H
authors.initials: H
authors.lastname: Moore
authors.forename: K
authors.initials: K
authors.lastname: Romeril
mesh_terms: D051722:ADAM Proteins / Q000097:blood; D000071120:ADAMTS13 Protein; D001897:Boronic Acids / Q000009:adverse effects*; D000069286:Bortezomib; D005260:Female; D005335:Fever of Unknown Origin / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D011719:Pyrazines / Q000009:adverse effects*
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human