A case of synchronous ileocecal adenocarcinoma and plasmacytoma initially presenting with multiple cerebral infarctions

Acute multiple cerebral infarctions as the initial manifestation of multiple primary malignant neoplasms are very rare. Studies have shown that it may even be the initial manifestation of occult systemic malignancy in up to 3% of patients. We retrospectively reported a 74-year-old male who initially presented with right hemiparesis. Magnetic resonance imaging and diffusion-weighted imaging of the brain showed acute small infarcts in the left parietal and right temporal lobes, and acute multiple cerebral infarctions were diagnosed. At the same time, computed tomography scans of the chest and abdomen revealed the concurrent ileocecal wall thickening and a left pleural mass with associated adjacent rib destruction. Subsequently, colonoscopy and biopsy of the rib lesion confirmed that the patient was diagnosed with synchronous ileocecal adenocarcinoma and plasmacytoma. Given that cerebral infarction may be the first sign of multiple primary malignant neoplasms, a precise etiological diagnosis is crucial to guiding treatment strategies and optimizing clinical prognosis.