• Cytogenetics in multiple myeloma is utilized to risk stratify patients into standard and high-risk groups. • Immunoglobulin heavy chain (IGH) gene translocations such as t(4;14) and t(14;16) are high-risk cytogenetic abnormalities that confer poor outcomes to therapy in multiple myeloma. • Primary IGH translocations are typically considered mutually exclusive events. • Here, we describe a case of multiple myeloma with dual primary IGH translocations involving both t(4;14) and t(14;16).
