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Multiple myeloma with hepatic amyloid light-chain amyloidosis manifesting as progressive liver failure.
BMJ Case Rep. 2020 Jun 29; 13(6)BC

Abstract

We present a case of a 45-year-old man admitted to the hospital with new-onset ascites and bilateral subconjunctival haemorrhages. He was found to have elevated liver enzymes in a hepatocellular pattern and direct hyperbilirubinemia. A diagnostic paracentesis was consistent with portal hypertension (PH). Extensive workup for acute and chronic liver disease was unremarkable. In the absence of clinical evidence of cirrhosis to explain PH, a liver biopsy with hepatic venous pressure gradient was pursued, which revealed proteinaceous material and apple-green birefringence under polarised light consistent with amyloid deposits. Bone marrow biopsy revealed plasma cell neoplasm with proteinaceous deposits consistent with concomitant multiple myeloma with AL amyloidosis. He developed rapidly progressive liver failure and passed shortly after presentation despite treatment with chemotherapy. This case illustrates how primary hepatic amyloidosis can present with a physiology that mimics cirrhosis and can easily be missed.

Authors+Show Affiliations

Internal Medicine, University of Florida Health at Jacksonville, Jacksonville, Florida, USA monique.oye@jax.ufl.edu.Internal Medicine, University of Florida Health at Jacksonville, Jacksonville, Florida, USA.Gastroenterology, University of Florida Health at Jacksonville, Jacksonville, Florida, USA.Pathology, University of Florida Health at Jacksonville, Jacksonville, Florida, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32601138

Citation

Oye, Monique, et al. "Multiple Myeloma With Hepatic Amyloid Light-chain Amyloidosis Manifesting as Progressive Liver Failure." BMJ Case Reports, vol. 13, no. 6, 2020.
Oye M, Sanders K, Ghali M, et al. Multiple myeloma with hepatic amyloid light-chain amyloidosis manifesting as progressive liver failure. BMJ Case Rep. 2020;13(6).
Oye, M., Sanders, K., Ghali, M., & Alkhasawneh, A. (2020). Multiple myeloma with hepatic amyloid light-chain amyloidosis manifesting as progressive liver failure. BMJ Case Reports, 13(6). https://doi.org/10.1136/bcr-2020-234637
Oye M, et al. Multiple Myeloma With Hepatic Amyloid Light-chain Amyloidosis Manifesting as Progressive Liver Failure. BMJ Case Rep. 2020 Jun 29;13(6) PubMed PMID: 32601138.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple myeloma with hepatic amyloid light-chain amyloidosis manifesting as progressive liver failure. AU - Oye,Monique, AU - Sanders,Kimberly, AU - Ghali,Maged, AU - Alkhasawneh,Ahmad, Y1 - 2020/06/29/ PY - 2020/7/1/entrez KW - liver disease KW - malignant and benign haematology KW - malignant disease and immunosuppression KW - ophthalmology KW - portal hypertension JF - BMJ case reports JO - BMJ Case Rep VL - 13 IS - 6 N2 - We present a case of a 45-year-old man admitted to the hospital with new-onset ascites and bilateral subconjunctival haemorrhages. He was found to have elevated liver enzymes in a hepatocellular pattern and direct hyperbilirubinemia. A diagnostic paracentesis was consistent with portal hypertension (PH). Extensive workup for acute and chronic liver disease was unremarkable. In the absence of clinical evidence of cirrhosis to explain PH, a liver biopsy with hepatic venous pressure gradient was pursued, which revealed proteinaceous material and apple-green birefringence under polarised light consistent with amyloid deposits. Bone marrow biopsy revealed plasma cell neoplasm with proteinaceous deposits consistent with concomitant multiple myeloma with AL amyloidosis. He developed rapidly progressive liver failure and passed shortly after presentation despite treatment with chemotherapy. This case illustrates how primary hepatic amyloidosis can present with a physiology that mimics cirrhosis and can easily be missed. SN - 1757-790X UR - https://www.unboundmedicine.com/medline/citation/32601138/Multiple_myeloma_with_hepatic_amyloid_light-chain_amyloidosis_manifesting_as_progressive_liver_failure L2 - https://casereports.bmj.com/cgi/pmidlookup?view=long&pmid=32601138 DB - PRIME DP - Unbound Medicine ER -
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