[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-454745-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-454745-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","a-case-of-atypical-acute-encephalopathy-unmasking-iga-multiple-myeloma","A Case of Atypical Acute Encephalopathy Unmasking IgA Multiple Myeloma","","Multiple myeloma can present insidiously, and its early delays can hinder diagnosis. Acute encephalopathy is a rare, atypical complication that can obscure timely recognition and treatment. The article reports a 57-year-old woman whose fatigue, back pain, recurrent falls, and major weight loss preceded findings of hypercalcemia, anemia, acute renal dysfunction, and bone lesions. Her illness progressed rapidly to profound encephalopathy, and extensive evaluation confirmed IgA lambda paraproteins consistent with MM.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/a-case-of-atypical-acute-encephalopathy-unmasking-iga-multiple-myeloma/454745/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/a-case-of-atypical-acute-encephalopathy-unmasking-iga-multiple-myeloma/454745.png","ImageObject",300,407,{"name":42,"@type":43},"Putri","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why can multiple myeloma cause delayed diagnosis in this case?","Question",{"text":63,"@type":64},"Multiple myeloma may start insidiously, particularly in early stages, which can contribute to delays in diagnosis and recognition of complications such as encephalopathy.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What clinical and laboratory findings supported IgA lambda multiple myeloma?",{"text":68,"@type":64},"Evaluation identified hypercalcemia, anemia, acute renal dysfunction, bone lesions, and elevated IgA lambda paraproteins on bone biopsy, consistent with multiple myeloma.",{"name":70,"@type":61,"acceptedAnswer":71},"What led to neurological improvement after encephalopathy persisted?",{"text":72,"@type":64},"Although plasmapheresis and high-dose steroids were tried, encephalopathy persisted until initiation of bortezomib-based chemotherapy, after which neurological improvement occurred.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},454745,1790902257,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":115,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962085571259,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","Review began 08/29/2025  \nReview ended 11/22/2025  \nPublished 12/08/2025  \n© Copyright 2025  \nAbad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98689  \nOpen Access Case Report  \nA Case of Atypical Acute Encephalopathy Unmasking IgA Multiple Myeloma  \nJamie T. Abad 1, Tasnim Rahman 1, Renieh Nabaty 1, Omar Abbas 2, Kunj Patel 1, Nicholas Sturla 3  \n1. Internal Medicine, Henry Ford Health System, Detroit, USA 2. Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, USA 3. Cardiology, Henry Ford Health System, Detroit, USA  \nCorresponding author: Jamie T. Abad, [jabad1@hfhs.org](jabad1@hfhs.org)  \nAbstract  \nMultiple myeloma (MM) can have an insidious onset, particularly in its early stages, which may contribute to delays in diagnosis. Acute encephalopathy is a rare and atypical manifestation of MM that can further complicate timely recognition and management. We present the case of a 57-year-old woman who initially reported fatigue, back pain, recurrent falls, and significant unintentional weight loss and was found to have hypercalcemia, anemia, acute renal dysfunction, and bone lesions. Her clinical course rapidly evolved into profound encephalopathy, characterized by a change in mentation from her baseline, agitation, and eventual unresponsiveness requiring intubation.  \nExtensive investigation, including a bone biopsy, revealed elevated IgA lambda paraproteins consistent with MM. She also had borderline serum hyperviscosity, mildly elevated ammonia levels, and diffuse microhemorrhages on brain MRI. Despite interventions, including plasmapheresis and high-dose steroids, her encephalopathy persisted until initiation of bortezomib-based chemotherapy, resulting in neurological improvement. This case emphasizes the importance of recognizing MM as a potential cause of unexplained encephalopathy and highlights the complexity of its neurological manifestations, underscoring the need for prompt hematologic evaluation and interdisciplinary management.  \nCategories: Neurology, Hematology, Oncology  \nKeywords: blood hyperviscosity, hyperammonemia encephalopathy, iga lambda multiple myeloma, multiple myeloma, myeloma-related encephalopathy  \nIntroduction  \nMultiple myeloma (MM) is a clonal plasma cell proliferative disorder characterized by an abnormal increase in monoclonal immunoglobulins or paraproteins. MM is predominantly seen in the geriatric population, with a median age at diagnosis of 69 years [1] . The accumulation of malignant plasma cells in the bone marrow can lead to specific end-organ damage. Most commonly, clinical manifestations include hypercalcemia, renal dysfunction, anemia, or bone pain accompanied by lytic lesions, summarized by the“CRAB” criteria (hypercalcemia, renal dysfunction, anemia, and bone lesions) . While the classic CRAB criteria are well recognized, neurological manifestations are less commonly encountered and often present diagnostic and therapeutic challenges. These complications are diverse, ranging from peripheral neuropathy to rarer but serious conditions such as CNS involvement and cerebrovascular events [2] .  \nEncephalopathy is particularly important to recognize. It encompasses a wide range of potential etiologies. In the context of MM, it can be a clinically significant neurological complication arising from multiple mechanisms, including metabolic derangements (such as hypercalcemia, uremia, or hyperviscosity), paraneoplastic syndromes, drug toxicity, or direct CNS involvement. Typically, acute encephalopathy presents with global cognitive dysfunction or altered consciousness and can be evaluated through laboratory testing, neuroimaging, and cerebrospinal fluid (CSF) analysis.  \nAlthough the precise pathophysiology of MM-induced encephalopathy rema","cbCaiqDRk3D5NRav","https://ap.wps.com/l/cbCaiqDRk3D5NRav","pdf",2733906,"English","# Abstract\n## Introduction\n## Case Presentation","[{\"question\":\"Why can multiple myeloma cause delayed diagnosis in this case?\",\"answer\":\"Multiple myeloma may start insidiously, particularly in early stages, which can contribute to delays in diagnosis and recognition of complications such as encephalopathy.\"},{\"question\":\"What clinical and laboratory findings supported IgA lambda multiple myeloma?\",\"answer\":\"Evaluation identified hypercalcemia, anemia, acute renal dysfunction, bone lesions, and elevated IgA lambda paraproteins on bone biopsy, consistent with multiple myeloma.\"},{\"question\":\"What led to neurological improvement after encephalopathy persisted?\",\"answer\":\"Although plasmapheresis and high-dose steroids were tried, encephalopathy persisted until initiation of bortezomib-based chemotherapy, after which neurological improvement occurred.\"}]","A Case of Atypical Acute Encephalopathy Unmasking IgA Multiple Myeloma | PDF",1790741261,23]