Symptomatic Multiple Myeloma in the Second Trimester of Pregnancy: A Case Report
Hacene Meriche
*
Department of Immunology, Clinic Sainte Therese UHC, Annaba, Algeria.
Sara Zaghez
Department of Immunology, Clinic Sainte Therese UHC, Annaba, Algeria.
Feriel Sandra Bouafia
Department of Immunology, Clinic Sainte Therese UHC, Annaba, Algeria.
Boutheina Abdaoui
Department of Immunology, Clinic Sainte Therese UHC, Annaba, Algeria.
Nacima Sabiha Gadiri
Department of Immunology, Clinic Sainte Therese UHC, Annaba, Algeria.
Hichem Frigaa
Department of Nephrology, Hospital Ibn Sina, UHC, Annaba, Algeria.
*Author to whom correspondence should be addressed.
Abstract
Multiple myeloma (MM) in pregnant women is a rare disease characterized by clonal proliferation of plasma cells producing monoclonal immunoglobulin, which suppresses the normal production of other antibodies and weakens the maternal immune response. Plasma cells release inflammatory cytokines (IL-6, TNF-α, IL-1β) that promote their survival and bone destruction. During pregnancy, maternal immunity shifts towards complex tolerance with decreased Th1 inflammatory responses, Th2 predominance, and increased regulatory T cells, which often masks MM and complicates its management. Treatment is generally deferred until after delivery to protect the fetus, with the VTD protocol then used to control the disease by reducing plasma cell proliferation and inflammation. This case illustrates the importance of simple tests such as serum protein electrophoresis in diagnosing unexplained anemia during pregnancy, and highlights the need for immunological monitoring and a multidisciplinary approach to optimize maternal and fetal prognosis.
Keywords: Multiple myeloma, pregnancy, anemia, monoclonal composant, electrophoresis