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Case report
Multiple myeloma with extensive AL amyloidosis presenting as chronic diarrhoea
  1. William Kogler1,
  2. Catarina Canha1,
  3. Raafat Makary2,
  4. Reeba Omman2 and
  5. Carmen Liliana Isache1
  1. 1Internal Medicine, UF Health Jacksonville, Jacksonville, Florida, USA
  2. 2Pathology, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, USA
  1. Correspondence to Dr William Kogler; william.kogler{at}jax.ufl.edu

Abstract

We present a 52-year-old man admitted to the hospital with diarrhoea and lower extremity weakness ongoing for the past 3 months. The patient was found to have malabsorptive diarrhoea, hypoproliferative anaemia and renal insufficiency with proteinuria. Extensive workup was performed including a bone marrow biopsy with 20% plasma cells, renal and duodenal biopsies with Congo-red staining revealed amyloid deposition. The patient was diagnosed with multiple myeloma and amyloidosis with gastrointestinal, kidney and nerve involvement explaining his presentation with diarrhoea, renal insufficiency and weakness. Throughout his admission, there were incidental findings of asymptomatic hypoglycaemia (serum blood glucose <40 mg/dL), which was later found to be caused by anti-insulin monoclonal antibodies produced by the neoplastic plasma cells. This is an extremely rare manifestation of multiple myeloma with only a few cases reported in the literature.

  • malabsorption
  • haematology (incl blood transfusion)
  • malignant and benign haematology
  • nephrotic syndrome
  • proteinurea
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Footnotes

  • Contributors WK provided direct patient care to patient, workup/diagnosis of patients condition, drafting of the case report, literature review and editing. CC provided direct patient care to patient, work up/diagnosis of patients condition, drafting of the case report, literature review, editing. RM produced and interpreted histological images and contributed in drafting of the case report, literature review and editing. RO produced and interpreted histological images and contributed in drafting of the case report, literature review and editing. CLI provided direct patient care to patient, workup/diagnosis of patients condition, drafting of the case report, literature review and editing.

  • 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 Obtained.

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

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