A 53-year-old woman was admitted to Calama city with a diagnosis of end-stage renal disease of unknown cause, on hemodialysis for one year.
During this period, weight loss of 30 kg, headache, polyneuropathic pain in gloves, calcetin and polyarthralgias were added.
In the last months, there had been a blunt, painless, progressive increase in volume in both shoulders, right forearm and both thighs, joint immobility of both hands and diarrhea in the last two weeks.
She was referred to our hospital for study of possible rheumatologic disease.
Physical examination revealed a cachectic, pale, prostrate patient.
He highlighted macroglossia with geographical tongue, fatty masses in both shoulders (periarticular) of 6 cm: shoulder pad sign, mass of 3 cm in the right forearm and 12 cm in both thighs contracture.
Laboratory tests showed hemoglobin 8.7 g/dL, creatinine 6.5 mg/dL, calcemia 12 mg/dL, albumin 1.9 g/L, total protein 5.4 g/dL and triglycerides 450 mg/dL.
Due to the strong suspicion of multiple myeloma and associated amyloidosis, myelogram showed an infiltrate of 25% plasma cells.
The bone marrow immunophenotype showed the presence of plasma cells with restriction fragmentary chain lambda and myeloma diagnosis.
Protein electrophoresis showed a small M component in G1 and quantification of very low immunoglobulins, IgA 27.7 mg/dL, IgG and IgM 8.8 mg/dL.
It was not possible to study proteinuria because the patient did not present diuresis.
Biopsy of the mass of the left thigh revealed fibrous connective tissue, scarce striated muscle tissue and positive deposits for Rojo Congo, confirming the diagnosis of amyloidosis.
Bone X-rays showed lytic lesions in the right hip and structures and increased soft tissue in correspondence to previously described masses, unrelated to bone.
An electromyography showed an attack neuropathy of the peroneal nerve and right median nerve.
A CT scan of the chest, abdomen and pelvis showed soft tissue deposits in the shoulders (periarticular), pericardium, intestinal wall, hepatomegaly and increased volume of the head of the pancreas.
No echocardiogram was performed.
It was concluded that they were multiple myeloma, associated amyloidosis and terminal renal failure.
She received bisphosphonates, with reduction of hypercalcemia and treatment with melphalan 10 mg/day and prednisone 40 mg/day for 4 days was initiated.
Thalidomide 50 mg/day was added.
Unfortunately, the patient died one month after treatment.
