Kidney failure as an unusual initial presentation of biclonal gammopathy (IgD multiple myeloma associated with light chain disease): A case report
Introduction. Immunoglobulin D (IgD) myeloma is a rare disease, about 2% of all myelomas, even rarer when accompanied with another multiple myeloma in biclonal gammopathy. We presented a case of biclonal gammopathy - associated manifestation of IgD myeloma and light chain disease in a patie...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2015-01-01
|
| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400027R.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Introduction. Immunoglobulin D (IgD) myeloma is a rare disease, about 2% of
all myelomas, even rarer when accompanied with another multiple myeloma in
biclonal gammopathy. We presented a case of biclonal gammopathy - associated
manifestation of IgD myeloma and light chain disease in a patient who
initially had renal failure. Case report. 37-year-old male approximately one
month before hospitalization began to feel malaise and fatigue along with
decreased urination. Laboratory analysis revealed azotemia. A dialysis
catheter was placed and hemodialysis started. The patient was then admitted
to our hospital for further tests and during admission, objective examination
revealed pronounced paleness with hepatosplenomegaly and hypertension (170/95
mmHg). Laboratory analysis showed erythrocyte sedimentation rate 122 mm/h,
expressed anemic syndrome (Hb 71 g/L) and renal failure dialysis rank:
creatinine 1,408 μmol/L, urea31.7 mmol/L. There was two M components in serum
protein electrophoresis: IgD lambda and free light chain lambda. Proteinuria
was nephrotic rank (5.4 g/24 h), whose electrophoresis revealed 2 M
components - massive in α 2 fraction of 71%; 7% in the discrete β fraction,
beta 2M /serum 110 mg/L, in urine 1.8 mg/L - extremely high; IgL kappa /
lambda index 1 : 13 (reference value ratio 2 : 1). The findings pointed to
double myeloma disease: IgD myeloma and Bence Jones lambda myeloma. Bone
biopsy confirmed IgD myeloma lambda 100% infiltration medulla predominantly
plasmablasts. The treatment continued with hemodialysis 3 times per week with
chemotherapy protocol bortezomib, doxorubicin, dexamethasone. After 4 cycles
of chemotherapy, there was a decrease of IgD, λ - light chains, reduction in
proteinuria (1.03 g/24 h), so hemodialysis was reduced to once per week. Six
months after treatment initiation the patient underwent autologous bone
marrow transplantation. In a 2-year follow-up period double myeloma disease
showed complete remission. Conclusion. The presented rare form of double
myeloma disease with initial renal insufficiency underscores the importance
of careful observation and team-work that can alter the course of this
serious disease. |
|---|---|
| ISSN: | 0042-8450 |