Tashima Yuko, Setoyama Koshi, Higashi Takehiro, Nawata Aya, Tanaka Fumihiro
Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, JPN.
Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, JPN.
Cureus. 2025 May 1;17(5):e83299. doi: 10.7759/cureus.83299. eCollection 2025 May.
Amyloid light-chain (AL) amyloidosis is a disorder caused by abnormal plasma cells, and it may develop either as a primary disease or as a secondary condition associated with multiple myeloma. Due to the absence of specific clinical symptoms, its diagnosis is often challenging. Here, we present a case of cardiac amyloidosis secondary to multiple myeloma, incidentally complicated by ductal carcinoma in situ (DCIS). Although the breast cancer was diagnosed as stage 0 (DCIS), the patient's heart failure symptoms worsened following surgical resection. As a result, further evaluation by the cardiology department was performed, leading to a diagnosis of cardiac amyloidosis. Subsequently, a hematology consultation was obtained, and bone marrow biopsy revealed that clonal plasma cells accounted for more than 60% of bone marrow cellularity, confirming a diagnosis of multiple myeloma. The patient received daratumumab + bortezomib + cyclophosphamide + dexamethasone therapy, achieved a partial response, and has been alive for >2 years. This case is a valuable example of a patient who experienced a gradual onset of the symptoms of amyloidosis, including palpitations, pleural effusion, right and left heart failure, before a diagnosis could be made. It took a total of eight departments to make a diagnosis, as it was challenging. Even if no abnormalities are observed in a single examination, it is important to listen carefully to patient complaints, repeat the examination if necessary, and work with multiple departments to provide treatment.
淀粉样轻链（AL）淀粉样变性是一种由异常浆细胞引起的疾病，它可能作为原发性疾病出现，也可能作为与多发性骨髓瘤相关的继发性疾病发展。由于缺乏特异性临床症状，其诊断往往具有挑战性。在此，我们报告一例继发于多发性骨髓瘤的心脏淀粉样变性病例，该病例意外合并原位导管癌（DCIS）。尽管乳腺癌被诊断为0期（DCIS），但患者在手术切除后心力衰竭症状恶化。因此，心内科进行了进一步评估，从而诊断为心脏淀粉样变性。随后，进行了血液科会诊，骨髓活检显示克隆性浆细胞占骨髓细胞成分的60%以上，确诊为多发性骨髓瘤。该患者接受了达雷妥尤单抗+硼替佐米+环磷酰胺+地塞米松治疗，取得了部分缓解，目前已存活超过2年。该病例是一个有价值的例子，说明患者在确诊前经历了淀粉样变性症状的逐渐出现，包括心悸、胸腔积液、左右心力衰竭。由于诊断具有挑战性，总共涉及八个科室才得以确诊。即使在单次检查中未观察到异常，认真听取患者主诉、必要时重复检查并与多个科室合作进行治疗也很重要。
