Hindosh Ziad, Potharaju Anil
Internal Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA.
Internal Medicine, Banner Health, Tucson, USA.
Cureus. 2023 Aug 28;15(8):e44286. doi: 10.7759/cureus.44286. eCollection 2023 Aug.
A 66-year-old Caucasian female with a recent history of COVID-19 (about one month prior to the current admission) and cirrhosis, presented with acute kidney injury (AKI) and worsening encephalopathy. Initial management focused on addressing her AKI, initially suspected to be secondary to volume depletion or hepatorenal syndrome (HRS) and confusion from hepatic encephalopathy. However, further evaluation unveiled a persistent serum protein gap, hypercalcemia, and significant non-albumin proteinuria, prompting a more comprehensive diagnostic approach. Subsequent investigations revealed a high serum free light chain ratio, positive serum protein electrophoresis, and monoclonal gammopathy, indicative of a plasma cell disorder. A bone survey did not indicate aggressive bone lesions, but a bone marrow biopsy confirmed multiple myeloma with approximately 10% kappa light chain-restricted plasma cells. Despite appropriate treatment, the patient's health continued to decline, and the patient was subsequently transitioned to comfort care. While the relationship between cirrhosis and multiple myeloma remains to be fully understood, our case report explores four potential explanations: coincidental coexistence, cirrhosis as a risk factor for multiple myeloma, multiple myeloma as a risk factor for cirrhosis, or a shared predisposing condition.
一名66岁的白种女性，近期有新冠病毒感染病史（本次入院前约1个月）且患有肝硬化，出现急性肾损伤（AKI）和肝性脑病加重。初始治疗重点是处理她的急性肾损伤，最初怀疑其继发于容量不足或肝肾综合征（HRS）以及肝性脑病所致的意识障碍。然而，进一步评估发现持续的血清蛋白差距、高钙血症和显著的非白蛋白蛋白尿，促使采取更全面的诊断方法。随后的检查显示血清游离轻链比值升高、血清蛋白电泳阳性和单克隆丙种球蛋白病，提示浆细胞疾病。骨扫描未显示侵袭性骨病变，但骨髓活检确诊为多发性骨髓瘤，约10%的浆细胞为κ轻链限制性。尽管进行了适当治疗，患者的健康状况仍持续恶化，随后转为姑息治疗。虽然肝硬化与多发性骨髓瘤之间的关系仍有待充分了解，但我们的病例报告探讨了四种潜在解释：巧合共存、肝硬化作为多发性骨髓瘤的危险因素、多发性骨髓瘤作为肝硬化的危险因素或共同的易感条件。
