Diagnostic and Critical Care Challenges in Rapidly Progressive Interstitial Lung Disease Secondary to Multiple Myeloma

The concurrent presentation of multiple myeloma (MM) and interstitial lung disease (ILD) remains exceptionally rare, with limited literature describing optimal management strategies for this dual pathology. We report a complex case of a 62-year-old male with newly diagnosed MM with intermediate-risk cytogenetics (del13q, gain 1q) who concurrently presented with rapidly progressive ILD demonstrating a usual interstitial pneumonia (UIP) pattern. The patient's 6-month clinical course was marked by multi-organ involvement, recurrent infections, thromboembolic complications, and multiple cardiopulmonary crises culminating in a fatal outcome. This case illustrates the profound diagnostic and therapeutic challenges when dual malignancy and progressive pulmonary fibrosis coexist, highlighting the need for aggressive multidisciplinary management, heightened awareness of infection risk, and early consideration of palliative care discussions.