232 A multidisciplinary case of multiple myeloma with cardiac and renal involvement: a look beyond amyloidosis

Abstract Aims Multiple myeloma (MM) is a malignant neoplasm with a frequent cardiac involvement characterized by restrictive cardiomyopathy. Kidney and thromboembolic complications are also described. Methods and results A 52-year-old woman with a history of kidney disease was admitted to nephrology department due to worsening of renal function and refractory hypertension. A bone marrow biopsy revealed the diagnosis of MM. A renal and fat pad biopsy with Congo red staining was performed but amyloid deposition was not observed. Increased cardiac enzymes suggested a cardiac involvement. Indeed, two intracardiac right-sided masses and massive pulmonary embolism were detected. Surgical cardiac intervention was promptly performed and a chemotherapy regimen was started. Meantime, a kidney biopsy revealed a light-chain deposition disease. Conclusions This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, in patients with not acute massive pulmonary embolism and intracardiac right masses, surgical pulmonary embolectomy should be promptly performed to preserve RV function and to avoid prevent pulmonary hypertension development.

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P0259PARAPROTEIN-RELATED RENAL LESIONS IN NEWLY DIAGNOSED MULTIPLE MYELOMA: CLINICAL AND PATHOLOGICAL CHARACTERISTIC OF 51 PATIENTS WITH KIDNEY BIOPSIES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0259 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Zishan Lin ◽

Xiaojuan Yu ◽

Suxia Wang ◽

Xinan Cen ◽

Fude Zhou ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Renal Involvement ◽

Laboratory Data ◽

Lower Percentage ◽

Newly Diagnosed ◽

Light Chain Deposition Disease ◽

Renal Lesions ◽

Common Diagnosis ◽

Male Sex

Abstract Background and Aims Renal involvement is common in multiple myeloma (MM). In this study, we examined kidney biopsy findings in patients with newly diagnosed MM (NDMM) and correlated them with clinical characteristics and survival. Method Renal pathological findings were retrospectively studied in 56 patients with NDMM. Clinical and laboratory data as well as outcomes were collected from 51 patients with paraprotein-related renal lesions in NDMM. Patients were categorized according to the with or without myeloma cast nephropathy (MCN). Results Among 56 patients with NDMM, 51 had paraprotein-related renal lesions, of which MCN was the most common lesion in 31 patients (60.8%), followed by amyloidosis in 12 patients (23.5%) and light chain deposition disease (LCDD) in 8 patients (15.7%). Five patients had nonparaprotein-associated lesions, of which minimal change disease was the most common diagnosis, seen in 3 patients (60%). Patients with MCN had significantly higher serum creatinine levels, a lower eGFR, a higher percentage of requiring dialysis at diagnosis, a higher incidence of progressing to end-stage renal disease (ESRD), lower hemoglobin levels, a lower percentage of albumin in urine protein, a higher level of serum albumin and were more likely to have a detectable M-spike but less likely to have a detectable monoclonal whole immunoglobulin than patients without MCN. Compared with patients with MCN, the median overall survival time of patients without MCN was significantly longer (not reached vs 39 months (95% CI: 9–69 months); P=0.047; Fig.1). According to the multivariate analysis, the independent predictors of overall survival were the number of myeloma casts (HR: 1.12, 95% CI: 1.07-1.25; P=0.014) and male sex (HR: 4.99, 95% CI: 1.36-18.38; P=0.016). Conclusion Patients with MCN suffer from more serious and more urgent renal damage and can also present with high-grade albuminuria but without hypoalbuminemia. The number of myeloma casts and male sex are independent predictors of overall survival.

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Early thrombolytic failure in a patient with massive pulmonary embolism combined with multiple organ dysfunction syndrome: what next?

Journal of International Medical Research ◽

10.1177/0300060518778120 ◽

2018 ◽

Vol 46 (8) ◽

pp. 3440-3445 ◽

Cited By ~ 2

Author(s):

Furong Liu ◽

Song Yang ◽

Weishuo Liu ◽

Baiyun Tang ◽

Wenbo Zhang ◽

...

Keyword(s):

Pulmonary Embolism ◽

Organ Dysfunction ◽

Multiple Organ Dysfunction Syndrome ◽

Massive Pulmonary Embolism ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Co Poisoning ◽

Difficult Decision ◽

Failure Assessment ◽

Surgical Embolectomy

Carbon monoxide (CO) poisoning, the most frequent type of poisoning, alters hemodynamics and creates tissue hypoxia that ultimately leads to thromboembolism. We herein describe a previously healthy 17-year-old male patient who developed acute CO poisoning while bathing in the same room as a gas heater. He was first treated with urokinase thrombolytic therapy at a local hospital, which proved ineffective. The patient was admitted to our hospital with unstable circulation and was diagnosed with massive pulmonary embolism combined with multiple organ dysfunction syndrome. His Acute Physiology and Chronic Health Evaluation II score was 22, and his Sequential Organ Failure Assessment score was 15. We faced a difficult decision regarding whether to perform surgical embolectomy or to repeat the thrombolysis. We opted to repeat the thrombolysis with successful results. Our experience may help clinicians manage similar cases in the future.

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Abstract #860 Massive Pulmonary Embolism as the First Presentation of a Patient with Acromegaly

Endocrine Practice ◽

10.1016/s1530-891x(20)47346-x ◽

2018 ◽

Vol 24 ◽

pp. 204-205

Author(s):

Wajiha Gul ◽

Mehdi Errayes ◽

Buthaina Alowainati

Keyword(s):

Pulmonary Embolism ◽

Massive Pulmonary Embolism

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COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

VASA ◽

10.1024/0301-1526/a000880 ◽

2020 ◽

Vol 49 (4) ◽

pp. 333-337 ◽

Cited By ~ 3

Author(s):

Francisco Leonardo Galastri ◽

Leonardo Guedes Moreira Valle ◽

Breno Boueri Affonso ◽

Marcela Juliano Silva ◽

Rodrigo Gobbo Garcia ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Dynamic Process ◽

Therapeutic Option ◽

Massive Pulmonary Embolism ◽

Percutaneous Intervention ◽

Thromboembolic Events ◽

Emergency Center ◽

Catheter Directed Thrombolysis

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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Endovascular repair of a spontaneous ilio-iliac fistula presenting as pulmonary embolism

VASA ◽

10.1024/0301-1526/a000100 ◽

2011 ◽

Vol 40 (3) ◽

pp. 246-250 ◽

Cited By ~ 4

Author(s):

Melas ◽

Saratzis ◽

Abbas ◽

Sarris ◽

Saratzis ◽

...

Keyword(s):

Pulmonary Embolism ◽

Endovascular Repair ◽

Therapeutic Option ◽

Artery Aneurysm ◽

Iliac Vein ◽

Massive Pulmonary Embolism ◽

Long Term Results ◽

Common Iliac Vein ◽

Iliac Artery Aneurysm ◽

Common Iliac Artery Aneurysm

Spontaneous rupture of a common iliac artery aneurysm into the common iliac vein is a rare phenomenon. We report the case of a 68 year old man admitted with acute cardiac failure and massive pulmonary embolism as a complication of a spontaneous ilio-iliac fistula, secondary to aneurysmal rupture. The aneurysm was successfully excluded using an aorto-uni-iliac stent graft. No complications were noted at 9 months follow-up. Arteriovenous fistulae should be considered in patients with aortic or iliac aneurysms who develop a pulmonary embolism or symptoms of venous congestion. Endovascular repair of these pathologies is a feasible therapeutic option; however long term results remain unknown.

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Recovery from LCDD-associated Severe Liver Cholestasis: a Case Report and Literature Review

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.251.lcd ◽

2016 ◽

Vol 25 (1) ◽

pp. 99-103 ◽

Cited By ~ 1

Author(s):

Benoit Brilland ◽

Johnny Sayegh ◽

Anne Croue ◽

Frank Bridoux ◽

Jean-François Subra ◽

...

Keyword(s):

Multiple Myeloma ◽

Light Chain ◽

Intrahepatic Cholestasis ◽

Relevant Literature ◽

Gamma Glutamyl Transferase ◽

Light Chain Deposition Disease ◽

Deposition Disease ◽

Uncommon Presentation ◽

Light Chain Deposition ◽

Glutamyl Transferase

Light chain deposition disease (LCDD) is a rare multisystemic disorder associated with plasma cell proliferation. It mainly affects the kidney, but liver and heart involvement may occur, sometimes mimicking the picture of systemic amyloidosis. Liver disease in LCDD is usually asymptomatic and exceptionally manifests with severe cholestatic hepatitis. We report the case of a 66-year-old female with κ-LCDD and cast nephropathy in the setting of symptomatic multiple myeloma who, after a first cycle of bortezomib-dexamethasone chemotherapy, developed severe and rapidly worsening intrahepatic cholestasis secondary to liver κ-light chain deposition. Intrahepatic cholestasis was attributed to LCDD on the basis of the liver histology and exclusion of possible diagnoses. Chemotherapy was maintained and resulted in progressive resolution of cholestasis. We report here an uncommon presentation of LCDD, with prominent liver involvement that fully recovered with bortezomib-based chemotherapy, and briefly review the relevant literature. Abbreviations: AKI: Acute kidney injury; ALP: alkaline phosphatase; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CMV: Cytomegalovirus; EBV: Epstein–Barr virus; GGT: gamma-glutamyl transferase; HSV: Herpes simplex virus; LC: light chain; LCDD: Light chain deposition disease; MIDD: Monoclonal immunoglobulin deposition disease; MM: Multiple myeloma.

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