Severe acute cholestatic hepatitis by infiltration of monoclonal plasma cells in multiple myeloma.
BACKGROUND
Plasma cell infiltration of the liver can be detected in 25 to 40% of patients with multiple myeloma. However, there are only rare cases of multiple myeloma clinically presenting as acute liver disease.


METHODS
We report an 88-year-old woman with painless jaundice and abnormal liver function tests, resembling acute cholestatic hepatitis. Viral hepatitis as well as autoimmune hepatitis could be excluded. Liver biopsy revealed a diffuse portal and sinusoidal infiltration of plasma cells with lambda light chain restriction. Serological immune fixation disclosed monoclonal gammopathy of IgG lambda with bone marrow infiltration of 25% plasma cells. After administration of 60 mg prednisolone per day, the elevated liver enzymes declined considerably.


CONCLUSIONS
Hepatic plasma cell infiltration of multiple myeloma can, in rare cases, manifest as acute cholestatic hepatitis, which may respond to treatment with corticosteroids.
Barth
C
C
Department of Internal Medicine, Gastroenterology, Hepatology and Oncology, Hospital Bad Cannstatt, Klinikum Stuttgart, Germany. c.barth@kbc-intern.de
Bosse
A
A
Andus
T
T
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006505:Hepatitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007122:Immunoelectrophoresis; D007146:Immunoglobulin lambda-Chains / Q000097:blood; D008099:Liver / Q000473:pathology; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis; D010950:Plasma Cells; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007146:Immunoglobulin lambda-Chains; D011239:Prednisolone