[A rare case of cholestasis and macrohematuria in a 52-year-old patient].
METHODS
We report of a 52-year-old man from Egypt who suffered from 20 kg weight loss within 6 months, jaundice, macrohematuria, and impaired renal function.
Due to the ultrasound and the CT scan of the abdomen, a kidney tumor was suspected. A nephrectomy was planned but the biopsy of the kidney and liver intraoperatively revealed amyloid deposits. A plasma cell dyscrasia of 15% was found by bone marrow biopsy. Immunfixation showed an IgG-kappa light chain in plasma and urine. There was no osteolysis throughout the skeletal system. Thus, the patient had a plasmacytoma Stage II associated with IgG-kappa light chain AL-amyloidosis which was treated by chemotherapy (melphalan and prednisolone).


CONCLUSIONS
This unusual case presents a cholestatic liver disease due to bile duct obstruction secondary to amyloid deposits. Although AL-amyloidosis is easily diagnosed by certain criteria, the disease is often recognized too late with consequently poor prognosis.
Arkenau
Hendrik-Tobias
HT
Klinik für Innere Medizin, Zentralkrankenhaus Bremen Ost, Bremen. harkenau@zkhobremen.de
Widjaja
Adji
A
D000682:Amyloid / Q000378:metabolism*; D000686:Amyloidosis / Q000175:diagnosis* / Q000473:pathology; D001853:Bone Marrow / Q000473:pathology; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D007147:Immunoglobulin Light Chains / Q000378:metabolism; D007145:Immunoglobulin kappa-Chains / Q000378:metabolism; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000175:diagnosis* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000473:pathology; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000473:pathology
D000682:Amyloid; D007074:Immunoglobulin G; D007147:Immunoglobulin Light Chains; D007145:Immunoglobulin kappa-Chains; C035222:amyloid protein AL