Disrupted care for multiple myeloma in an amenorrheic woman due to a false-positive pregnancy test: A case report

We report the case of a 48-year-old female with a history of tubal ligation who presented to her PCP with altered mental status and back pain. Inpatient workup revealed multiple myeloma, and treatment with bortezomib and dexamethasone was initiated. Due to teratogenicity on lenalidomide, a pre-treatment urine pregnancy test was performed and returned positive. She denied sexual activity and had no history of germ cell tumor. While urine hCG remained low positive for three tests, her serum hCG remained normal (<5 mIU/mL). The uncertainty in pregnancy testing caused a delay in full-dose induction therapy. With two cycles of bortezomib and dexamethasone, her M-Spike only dropped from 4.8 to 2.9 g/dL. Ultimately urine hCG normalized, and she was started on lenalidomide with cycle number three. With the addition of lenalidomide, after two cycles, her M-Spike disappeared, and bone marrow biopsy showed complete resolution of plasma cell dyscrasia. The phenomenon of positive hCG testing in multiple myeloma is discussed, highlighting the importance of provider and patient awareness in the setting of a non-gravid woman to prevent a disruption of standard of care treatment and patient distress.