Kumar Pirkash, Borz-Baba Carolina, Raissi Sina
Internal Medicine, Saint Mary's Hospital, Waterbury, USA.
Medicine, Saint Mary's Hospital, Waterbury, USA.
Cureus. 2019 Sep 16;11(9):e5669. doi: 10.7759/cureus.5669.
Immunoglobulin D (IgD) monoclonal gammopathy is a rare subtype of multiple myeloma (MM) associated with a worse prognosis compared with other variants of MM. A 61-year-old man with no known past medical history presented with complaints of abdominal pain, nausea, and vomiting for three weeks. Physical examination revealed mild epigastric tenderness. Laboratory data demonstrated a significantly elevated creatinine with minimal proteinuria and small abnormality in the gamma fraction. Ultrasound of the kidneys described normal-sized kidneys. Serum-free light chains and immunofixation were consistent with IgD kappa monoclonal gammopathy. Kidney biopsy revealed cast nephropathy. Bone marrow biopsy was remarkable for sheets of CD 38+ plasma cells comprising approximately 80% of the marrow cells. Recognizing the atypical presentation of IgD MM is crucial to facilitate early diagnosis and management and improve the prognosis of this subtype of MM.
免疫球蛋白D（IgD）单克隆丙种球蛋白病是多发性骨髓瘤（MM）的一种罕见亚型，与MM的其他变体相比，其预后更差。一名61岁男性，既往无已知病史，因腹痛、恶心和呕吐3周就诊。体格检查发现上腹部轻度压痛。实验室检查数据显示肌酐显著升高，蛋白尿极少，γ球蛋白部分有轻微异常。肾脏超声显示肾脏大小正常。血清游离轻链和免疫固定电泳结果符合IgD κ单克隆丙种球蛋白病。肾脏活检显示管型肾病。骨髓活检显示成片的CD 38+浆细胞，约占骨髓细胞的80%。认识到IgD MM的非典型表现对于促进早期诊断和治疗以及改善这种MM亚型的预后至关重要。
