Int J Cur Res Rev | Vol 13 • Issue 17 • September 2021 80 Multiple Myeloma Presenting as Fatal Hyperviscosity Syndrome: A Rare Case Report Jahnabi Bhagawati 1 , Abhijeet Kumar Agrawal 1 , Sunil Kumar 2 , Sourya Acharya 3 1 Assistant Professor, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India; 2 Professor, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India; 3 Professor and Head of Department, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India. Corresponding Author: Dr. Abhijeet Kumar Agrawal, Assistant Professor, Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi, Wardha, Maharashtra, India; Mobile: 9767611889; Email: Abhijeet.agrawal89@gmail.com ISSN: 2231-2196 (Print) ISSN: 0975-5241 (Online) Received: 07.01.2021 Revised: 12.02.2021 Accepted: 23.03.2021 Published: 12.09.2021 INTRODUCTION Among plasma cell neoplasms, the most common is mul- tiple myeloma. Other included neoplasms are MGUS (monoclonal gammopathies of unknown significance), plasma cell leukaemia, and plasmacytomas. Plasmacy- toma is a localized form of neoplasm that is further clas- sified into SPB (solitary plasmacytoma of bone) and EMP (extramedullary plasmacytoma) with each of them form- ing only < 4% of neoplasm burden whereas multiple my- eloma forms the systemic disease. 1 Multiple myeloma, a neoplastic lymphoproliferative B-cell systemic malignant disease depicts non prohibited plasma cell (monoclonal) proliferation inside bone marrow resulting in flooding of peripheral blood with immunoglobulins that are non- functional. 2 Blood Hyperviscosity Syndrome (BHVS) encompasses clin- ical features due to increased blood or plasma viscosity. 3 HVS presents with a classical triad of neurological manifestations, visual disturbances, and mucosal bleeding. Universal find- ings in cases of HVS would be epistaxis, oral bleeding, and visual symptoms. Evaluation of patients with Hyperviscos- ity syndrome must include a clinical history of any haema- tological disease or a similar disorder that runs in family. Impaired platelet function gives rise to bleeding in the form of Gastrointestinal bleed or epistaxis. The neurological man- ifestations are due to impaired blood supply to the central nervous system, the peripheral nerves however are affected due to paraproteins getting deposited in their myelin sheath. Patients show easy bruising with characteristic evidence on retinal examination (thick veins, haemorrhages, and papilledema). Patients may develop visual symptoms in the International Journal of Current Research and Review DOI: http://dx.doi.org/10.31782/IJCRR.2021.131716 IJCRR Section: Healthcare ISI Impact Factor (2019-20): 1.628 IC Value (2019): 90.81 SJIF (2020) = 7.893 Copyright@IJCRR ABSTRACT Introduction: Hyperviscosity syndrome is regarded as a rare oncological emergency with a bleak prognosis. Though it is more commonly found in patients of Waldenstrom’s macroglobulinemia and only 2-6% cases are reported in multiple myeloma. Aim: To highlight the therapeutic burden vindicated by Hyperviscosity syndrome over a case of multiple myeloma. Case Report: A 46-Year-old male patient presented to the emergency department with a history of two episodes of epistaxis with a mild headache for a few hours. The patient gave a history of bony pain at night. On investigation, the patient’s complete blood count revealed Hb-1.2g/dl, TLC-6300 cells, platelet count -77 lakhs/cu mm) and Peripheral smear-showed RBC in rouleaux formation. Bone marrow showed myeloma cells. X-ray skull [lateral view] showed punched out lytic lesions. Urine examination showed no Benz Jones proteins. Hyperviscosity syndrome ultimately leads to the patient’s demise. Methods: We are reporting a case of multiple myeloma in a 46-year-old male who presented with epistaxis and acute kidney injury as part of Hyperviscosity syndrome. The database was searched from google, PubMed, Scopus and web of science. Conclusion: This case report represents the minority of multiple myeloma patients. This case report represents the minority of multiple myeloma patients. Hyperviscosity syndrome presents as a significant touchstone when dealing with patients with mul- tiple myeloma and the complications following HVS can be often fatal while the patient may present with varied clinical features each separate time. Key Words: Hyperviscosity syndrome, Waldenstrom’s macroglobulinemia, Multiple Myeloma, Epistaxis, Acute Kidney Injury Case Report