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Case report
Rare case of acute on chronic hepatic failure in a patient with multiple myeloma-associated amyloidosis
  1. Muzammil Muhammad Khan1,
  2. Mamoon Ur Rashid2,
  3. Waqas Ullah3,
  4. Ishtiaq Hussain4 and
  5. Abu Hurairah2
  1. 1Internal Medicine, Khyber Medical College, Peshawar, Pakistan
  2. 2Internal Medicine, AdventHealth Dade City, Dade City, Florida, USA
  3. 3Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
  4. 4Internal Medicine, Mardan Medical Complex, Mardan, Khyber Pakhtunkhwa, Pakistan
  1. Correspondence to Dr Waqas Ullah; waqasullah.dr{at}


Amyloidosis is the extracellular deposition of unique protein fibrils in different tissue organs. It is most commonly associated with B-cell malignancy such as multiple myeloma or Waldenstrom macroglobulinaemia. It involves the liver, heart, kidney, peripheral nerves and soft tissues. Liver however is affected, but clinically apparent disease is very rare. Hepatomegaly and mild elevation of alkaline phosphatase is the most common presentation in patients with liver involvement. Acute hepatic failure is a rare presentation with myeloma-induced amyloidosis. The diagnosis can be difficult requiring biopsy or sometimes special staining of the tissue. Management is still very challenging

  • gastroenterology
  • liver disease
  • oncology

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  • Contributors MMK coordinated the data collection. MUR did the statistical analysis and wrote the manuscript. WU helped in reference arrangement and data mining. IH did the critical review. AH did the supervision and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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