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IgD myeloma with systemic amyloidosis with chest discomfort as an initial symptom.
Keio J Med. 2004 Sep; 53(3):178-90.KJ

Abstract

A 53-year-old man was admitted to Keio University Hospital because of serious dyspnea and edema of the lower extremities. Eighteen months previously, the patient had complained of chest discomfort, and was then admitted for the first time to our hospital for evaluation of chest pain. Electrocardiography showed poor R wave progression in leads Vl through V4, and diffuse nonspecific ST-segment and T wave abnormalities with low voltage. However, no definitive diagnosis could be made at this initial admission and a calcium-channel blocker was prescribed. Despite this treatment, the patient was readmitted with worsening dyspnea and lower extremity edema. The diagnosis of heart failure and nephritic syndrome was made at the second admission. In addition, immunoelectrophoresis showed a monoclonal IgD (lambda) M protein and increased plasma cells in the bone marrow, suggesting a diagnosis of multiple myeloma. The patient was thus given dexamethasone (20 mg per day for 4 days) intravenously, but his symptoms did not improve. Two weeks later, the patient deteriorated further with congestive heart failure and renal failure, and subsequently died of cardiac arrest with ventricular fibrillation. On autopsy, IgD (lambda)-positive plasma cell proliferation was found in the bone marrow, confirming the diagnosis of multiple myeloma. In addition, amyloid deposition was detected in various organs including the heart, kidneys, esophagus, duodenum, ileum, colon, tongue, and lungs. In particular, the weight of the heart was 650 g demonstrating a hypertrophic septum and amyloid deposition in the myocardium and even coronary arteries. In summary, the final diagnosis was IgD (lambda) multiple myeloma associated with systemic amyloidosis.

Authors+Show Affiliations

Departments of Internal Medicine, Emergency Medicine, School of Medicine, Keio University Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Clinical Conference
Journal Article

Language

eng

PubMed ID

15477732

Citation

Kizaki, Masahiro, et al. "IgD Myeloma With Systemic Amyloidosis With Chest Discomfort as an Initial Symptom." The Keio Journal of Medicine, vol. 53, no. 3, 2004, pp. 178-90.
Kizaki M, Ieda M, Satoh T, et al. IgD myeloma with systemic amyloidosis with chest discomfort as an initial symptom. Keio J Med. 2004;53(3):178-90.
Kizaki, M., Ieda, M., Satoh, T., Awaya, N., Hattori, Y., Kumagai, H., Hori, S., Mori, T., & Rao, H. (2004). IgD myeloma with systemic amyloidosis with chest discomfort as an initial symptom. The Keio Journal of Medicine, 53(3), 178-90.
Kizaki M, et al. IgD Myeloma With Systemic Amyloidosis With Chest Discomfort as an Initial Symptom. Keio J Med. 2004;53(3):178-90. PubMed PMID: 15477732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - IgD myeloma with systemic amyloidosis with chest discomfort as an initial symptom. AU - Kizaki,Masahiro, AU - Ieda,Masaki, AU - Satoh,Toru, AU - Awaya,Norihiro, AU - Hattori,Yutaka, AU - Kumagai,Hiroo, AU - Hori,Shingo, AU - Mori,Taisuke, AU - Rao,Harsha, PY - 2004/10/13/pubmed PY - 2004/11/9/medline PY - 2004/10/13/entrez SP - 178 EP - 90 JF - The Keio journal of medicine JO - Keio J Med VL - 53 IS - 3 N2 - A 53-year-old man was admitted to Keio University Hospital because of serious dyspnea and edema of the lower extremities. Eighteen months previously, the patient had complained of chest discomfort, and was then admitted for the first time to our hospital for evaluation of chest pain. Electrocardiography showed poor R wave progression in leads Vl through V4, and diffuse nonspecific ST-segment and T wave abnormalities with low voltage. However, no definitive diagnosis could be made at this initial admission and a calcium-channel blocker was prescribed. Despite this treatment, the patient was readmitted with worsening dyspnea and lower extremity edema. The diagnosis of heart failure and nephritic syndrome was made at the second admission. In addition, immunoelectrophoresis showed a monoclonal IgD (lambda) M protein and increased plasma cells in the bone marrow, suggesting a diagnosis of multiple myeloma. The patient was thus given dexamethasone (20 mg per day for 4 days) intravenously, but his symptoms did not improve. Two weeks later, the patient deteriorated further with congestive heart failure and renal failure, and subsequently died of cardiac arrest with ventricular fibrillation. On autopsy, IgD (lambda)-positive plasma cell proliferation was found in the bone marrow, confirming the diagnosis of multiple myeloma. In addition, amyloid deposition was detected in various organs including the heart, kidneys, esophagus, duodenum, ileum, colon, tongue, and lungs. In particular, the weight of the heart was 650 g demonstrating a hypertrophic septum and amyloid deposition in the myocardium and even coronary arteries. In summary, the final diagnosis was IgD (lambda) multiple myeloma associated with systemic amyloidosis. SN - 0022-9717 UR - https://www.unboundmedicine.com/medline/citation/15477732/IgD_myeloma_with_systemic_amyloidosis_with_chest_discomfort_as_an_initial_symptom_ L2 - https://japanlinkcenter.org/JST.JSTAGE/kjm/53.178?from=PubMed DB - PRIME DP - Unbound Medicine ER -