Muchtar Eli, King Rebecca L, McPhail Ellen D, Thorpe Matthew P, Gonsalves Wilson, Ernste Floranne, Grogan Martha, Dispenzieri Angela, Gertz Morie A
Division of Hematology Mayo Clinic Rochester, MN, United States.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
Leuk Res Rep. 2021 Apr 24;15:100242. doi: 10.1016/j.lrr.2021.100242. eCollection 2021.
We report a case of smoldering multiple myeloma patient who developed signs and symptoms consistent with polyarthritis. A PET-CT demonstrated marked FDG activity in multiple joints, concerning for inflammatory arthritis. Arthrocentesis from the glenohumeral joint was consistent with inflammatory synovial fluid with no evidence for infection or crystals. Congo-red stain of the synovial fluid was positive, and mass-spectrometry based amyloid typing was consistent with wild-type transthyretin type. The patient responded instantly to glucocorticoids. This case reports highlights the feasibility of non-tissue diagnosis of amyloidosis using body fluids and underscores the importance of accurate typing to avoid erroneous treatment.
我们报告一例冒烟型多发性骨髓瘤患者，其出现了与多关节炎相符的体征和症状。正电子发射断层扫描-计算机断层扫描（PET-CT）显示多个关节有明显的氟代脱氧葡萄糖（FDG）活性，提示炎性关节炎。肱盂关节穿刺抽出的关节液符合炎性滑膜液表现，未发现感染或晶体证据。滑膜液刚果红染色呈阳性，基于质谱的淀粉样蛋白分型与野生型转甲状腺素蛋白型相符。患者对糖皮质激素治疗立即产生反应。本病例报告强调了使用体液对淀粉样变性进行非组织诊断的可行性，并强调了准确分型以避免错误治疗的重要性。
