Maisuradze Nodari, Ghanie Nazeera, Kurnick Adam, Gooden Micha, Ahmed Rafsan
Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA.
Cureus. 2022 Sep 27;14(9):e29658. doi: 10.7759/cureus.29658. eCollection 2022 Sep.
Amyloid deposition in the setting of multiple myeloma (MM) is a well-documented phenomenon. In this paper, we present the rare case of a 62-year-old male who presented with decompensated heart failure in the setting of cardiac amyloid deposition as the initial presentation of MM. The patient presented to the emergency department with two weeks of worsening lower extremity edema. Laboratory exam revealed elevated troponin I, elevated B-type natriuretic peptide (BNP), macrocytosis, increased urine protein/creatinine ratio, and a monoclonal peak on both serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP). Transthoracic echocardiogram (TTE) revealed findings suggestive of amyloidosis. Abdominal fat pad biopsy confirmed amyloid deposition. The patient did not have other symptoms typically seen in multiple myeloma, such as fatigue or weakness, bone pain, or weight loss. In conclusion, we present a rare case of decompensated heart failure in the setting of amyloidosis as the initial presentation of multiple myeloma.
淀粉样蛋白在多发性骨髓瘤（MM）患者中沉积是一个有充分文献记载的现象。在本文中，我们报告了一例罕见病例，一名62岁男性，以心脏淀粉样蛋白沉积导致的失代偿性心力衰竭为首发表现，初诊为多发性骨髓瘤。该患者因下肢水肿加重两周就诊于急诊科。实验室检查显示肌钙蛋白I升高、B型利钠肽（BNP）升高、大细胞性贫血、尿蛋白/肌酐比值增加，血清蛋白电泳（SPEP）和尿蛋白电泳（UPEP）均出现单克隆峰。经胸超声心动图（TTE）显示有提示淀粉样变性的表现。腹部脂肪垫活检证实有淀粉样蛋白沉积。该患者没有多发性骨髓瘤常见的其他症状，如疲劳或虚弱、骨痛或体重减轻。总之，我们报告了一例罕见病例，以淀粉样变性导致的失代偿性心力衰竭为多发性骨髓瘤的首发表现。
