Ischemic colitis diagnosed by magnetic resonance imaging during lenalidomide treatment in a patient with relapsed multiple myeloma

Introduction: Multiple myeloma is the second most common hematological neoplasm that also affects young patients. The progression-free survival after autologous stem cell transplant has improved with the introduction of several novel agents such as lenalidomide, which may, however, increase the risk of adverse events. Methods: We describe the case of a 54-year-old woman with relapse of multiple myeloma 3 years after myeloablative allogeneic stem cell transplant who developed abdominal pain and bloody diarrhea following 7 months of lenalidomide therapy. Results: Abdominal plain x-ray and magnetic resonance imaging (MRI) without intravenous contrast material showed left-sided and splenic flexure acute ischemic colitis with reperfusion phenomena. Continuous intravenous infusion of unfractionated heparin was given with metronidazole and meropenem and the patient improved within a few days. MRI performed 15 days later confirmed complete recovery of ischemic colitis. Conclusions: To our knowledge there have been no previously reported cases of ischemic colitis during lenalidomide therapy as a single agent in relapsed or refractory multiple myeloma, in particular promptly diagnosed by MRI.