Background: Multiple myeloma (MM) is a kind of malignant plasma cell disease which can lead to disturbance in coagulation system. Cases of coagulopathy caused by MM and treatment-associated thrombosis have been reported. But cases of venous thrombosis as the first presentation of MM had rarely been reported.

Aims: To report two cases presented with venous thrombosis or pulmonary embolism (PE) before they were diagnosed with MM.

Methods: Case 1 was a 45-year-old male patient who was diagnosed intracranial venal sinus thrombosis with cranial MR contrast imaging. Anticoagulation therapy partially relieved his condition. 4 months later, he was diagnosed IgG-type MM. Case 2 was a 28-year-old female who was found to have portal vein, splenic vein thrombosis and superior mesenteric vein thrombosis and received interventional therapy and anticoagulation therapy. Four months later, she was diagnoses MM. She had received splenectomy and cholecystectomy a year before due to epigastric pain and splenomegaly as a result of β-thalassemia and chronic hepatitis B. She had high platelet count and positive lupus anticoagulant.

Results: In case 1, With anticoagulation and chemotherapy, the intracranial sinus thrombosis was cleared 2 months later. The thrombosis did not recur for four years now and his MM was in partial remission. In case 2, anticoagulation and chemotherapy for MM had to be suspended constantly due to recurrent upper digestive bleeding. Her MM was in remission after courses of chemotherapy. But, unfortunately, she died of delayed treatment for PE after she discontinued anticoagulants and had diarrhea.
The report here has got informed consent from the patient and their relatives.

Conclusions: DVT can be the first presentation of MM and should be paid attention to and serum Ig concentration should be checked. Successful treatment of MM together with anticoagulation therapy is helpful for the clearance of thrombosis.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/venous-thromboembolism-as-the-first-presentation-of-multiple-myeloma/