Liver Cirrhosis as a Rare Manifestation of IgA Myeloma: Diagnostic Challenge and Clinical Insight

Background: Liver involvement in multiple myeloma is rare and often underrecognized, typically presenting as hepatic infiltration by plasma cells or as amyloidosis. Cirrhosis secondary to multiple myeloma is an uncommon and poorly understood phenomenon. Case presentation: We present the case of an 84-year-old male with a known history of hypertension and no significant alcohol use, who was admitted with fatigue, weakness, lumbar pain, hypotension, diarrhea, and abdominal distension. Clinical evaluation and diagnostic imaging revealed signs of decompensated liver disease, including ascites and hepatomegaly with coarse echotexture. Extensive laboratory analyses and bone marrow findings were indicative of multiple myeloma. Other common causes of cirrhosis, such as alcohol, viral hepatitis, autoimmune hepatitis, cardiac liver disease, and metabolic liver disease, were ruled out. This case illustrates a rare hepatic manifestation of multiple myeloma that mimicked cryptogenic cirrhosis, underlining the diagnostic importance of considering hematologic malignancies. Conclusion: In elderly patients presenting with unexplained liver dysfunction and systemic symptoms, especially in the absence of conventional risk factors for liver disease, multiple myeloma should be considered in the differential diagnosis. This case emphasizes the importance of considering hematologic malignancies in the diagnostic workup of cryptogenic cirrhosis.