title: Multiple myeloma associated with serum amino acid disturbance and high output cardiac failure.
abstract: We experienced a plasma cell leukemia (PCL) patient complicated with high output cardiac failure (HOCF), proved as his elevated cardiac index and pulmonary artery wedge pressure and decreased systemic vascular resistance index in a hemodynamic study. We found no possible causes of HOCF. Interestingly, HOCF was improved as PCL responded to intensive chemotherapy. On the other hand, he showed consciousness disturbance, and had frequent attacks of generalized seizure. His electroencephalogram showed slow waves, and a spike and wave complex. Hyperammonemia and abnormal amino acid distribution were also found. This abnormal serum amino acid distribution, especially elevated glycine level, was different from that seen in chronic liver failure, and he had no hepatic disease. After intensive chemotherapy, the serum ammonia level and glycine level decreased. In this patient, PCL seemed to be responsible for HOCF, hyperammonemia, and abnormal amino acid distribution. We experienced two more cases of multiple myeloma (MM) with HOCF, hyperammonemia, abnormal serum amino acid distribution, and consciousness disturbance of unknown origin. Those two cases showed slow waves in the electroencephalogram. Improvement was seen in their HOCF, hyperammonemia, and abnormal amino acid levels after chemotherapy. The possibility of MM as a cause of HOCF is discussed.
authors.affiliation: The Second Department of Internal Medicine, Kumamoto University School of Medicine, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kuribayashi
authors.forename: H
authors.initials: H
authors.lastname: Matsuzaki
authors.forename: H
authors.initials: H
authors.lastname: Hata
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: T
authors.initials: T
authors.lastname: Sonoki
authors.forename: A
authors.initials: A
authors.lastname: Nagasaki
authors.forename: T
authors.initials: T
authors.lastname: Kimura
authors.forename: K
authors.initials: K
authors.lastname: Okamoto
authors.forename: M
authors.initials: M
authors.lastname: Kurose
authors.forename: H
authors.initials: H
authors.lastname: Tsuda
authors.forename: K
authors.initials: K
authors.lastname: Takatsuki
mesh_terms: D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000097:blood*; D002302:Cardiac Output; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000150:complications*
chemical_list: D000596:Amino Acids