A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis
Abstract Background Multiple myeloma (MM) is a malignant neoplasm associated with kidney involvement in nearly half of the patients. Cast nephropathy, monoclonal immunoglobulin deposition disease (MIDD), and light chain (AL) amyloidosis are the most common monoclonal immunoglobulin-mediated causes o...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-022-02984-4 |
| _version_ | 1811217678169276416 |
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| author | Samantha Innocenti Beatrice Bacchi Marco Allinovi Federico Perfetto Elisabetta Antonioli Niccolo’ Marchionni Carlo Di Mario Leonardo Caroti Francesco Cappelli Pierluigi Stefàno |
| author_facet | Samantha Innocenti Beatrice Bacchi Marco Allinovi Federico Perfetto Elisabetta Antonioli Niccolo’ Marchionni Carlo Di Mario Leonardo Caroti Francesco Cappelli Pierluigi Stefàno |
| author_sort | Samantha Innocenti |
| collection | DOAJ |
| description | Abstract Background Multiple myeloma (MM) is a malignant neoplasm associated with kidney involvement in nearly half of the patients. Cast nephropathy, monoclonal immunoglobulin deposition disease (MIDD), and light chain (AL) amyloidosis are the most common monoclonal immunoglobulin-mediated causes of renal injury. Cardiac involvement is also present in MM, characterized by restrictive cardiomyopathy generated by light chain deposit or amyloid. Thromboembolic complications such as deep vein thrombosis or pulmonary embolism are also described. Case presentation We present an unusual multidisciplinary case of a woman with a newly diagnosed MM associated with severe proteinuria and high natriuretic peptide. A renal and fat pad biopsy with Congo red staining were performed but amyloid deposition was not discovered. While immunofluorescence on fresh frozen unfixed tissue was not contributory, the immunofluorescence on fixed tissue and electron microscopy revealed the correct diagnosis. During subsequent investigations, two intracardiac right-sided masses and massive pulmonary embolism were also detected. Conclusions This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, renal diseases induced by monoclonal gammopathies are a group of complex and heterogeneous disorders. Their subtle presentation and their potential multiorgan involvement require the expertise of a multidisciplinary team able to provide the most appropriate diagnostic and therapeutic assessment. |
| first_indexed | 2024-04-12T06:58:49Z |
| format | Article |
| id | doaj.art-083f2131320c4286a00b6cc0e1b781b2 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-12T06:58:49Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-083f2131320c4286a00b6cc0e1b781b22022-12-22T03:43:03ZengBMCBMC Nephrology1471-23692022-11-012311810.1186/s12882-022-02984-4A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosisSamantha Innocenti0Beatrice Bacchi1Marco Allinovi2Federico Perfetto3Elisabetta Antonioli4Niccolo’ Marchionni5Carlo Di Mario6Leonardo Caroti7Francesco Cappelli8Pierluigi Stefàno9Nephrology, Dialysis and Transplantation Unit, Careggi University HospitalDepartment of Cardiac Surgery, Careggi University HospitalNephrology, Dialysis and Transplantation Unit, Careggi University HospitalTuscan Regional Amyloid Center, Careggi University HospitalHaematology Unit, Careggi University HospitalDepartment of Cardiothoracovascular Medicine, Careggi University Hospital, University of FlorenceDivision of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University HospitalNephrology, Dialysis and Transplantation Unit, Careggi University HospitalTuscan Regional Amyloid Center, Careggi University HospitalDepartment of Cardiac Surgery, Careggi University HospitalAbstract Background Multiple myeloma (MM) is a malignant neoplasm associated with kidney involvement in nearly half of the patients. Cast nephropathy, monoclonal immunoglobulin deposition disease (MIDD), and light chain (AL) amyloidosis are the most common monoclonal immunoglobulin-mediated causes of renal injury. Cardiac involvement is also present in MM, characterized by restrictive cardiomyopathy generated by light chain deposit or amyloid. Thromboembolic complications such as deep vein thrombosis or pulmonary embolism are also described. Case presentation We present an unusual multidisciplinary case of a woman with a newly diagnosed MM associated with severe proteinuria and high natriuretic peptide. A renal and fat pad biopsy with Congo red staining were performed but amyloid deposition was not discovered. While immunofluorescence on fresh frozen unfixed tissue was not contributory, the immunofluorescence on fixed tissue and electron microscopy revealed the correct diagnosis. During subsequent investigations, two intracardiac right-sided masses and massive pulmonary embolism were also detected. Conclusions This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, renal diseases induced by monoclonal gammopathies are a group of complex and heterogeneous disorders. Their subtle presentation and their potential multiorgan involvement require the expertise of a multidisciplinary team able to provide the most appropriate diagnostic and therapeutic assessment.https://doi.org/10.1186/s12882-022-02984-4Multiple myelomaAmyloidosisLight-chain deposition diseaseRenal vein thrombosisIntracardiac thrombi |
| spellingShingle | Samantha Innocenti Beatrice Bacchi Marco Allinovi Federico Perfetto Elisabetta Antonioli Niccolo’ Marchionni Carlo Di Mario Leonardo Caroti Francesco Cappelli Pierluigi Stefàno A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis BMC Nephrology Multiple myeloma Amyloidosis Light-chain deposition disease Renal vein thrombosis Intracardiac thrombi |
| title | A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis |
| title_full | A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis |
| title_fullStr | A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis |
| title_full_unstemmed | A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis |
| title_short | A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis |
| title_sort | multidisciplinary case report of multiple myeloma with renal and cardiac involvement a look beyond amyloidosis |
| topic | Multiple myeloma Amyloidosis Light-chain deposition disease Renal vein thrombosis Intracardiac thrombi |
| url | https://doi.org/10.1186/s12882-022-02984-4 |
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