[Middle-aged female presenting with headache,  blurred vision and skin rash].
BACKGROUND
Autoimmune hyperlipidemia (AIH) is a rare cause of secondary hyperlipidemia. A few cases of AIH have been reported in multiple myeloma.


METHODS
A female in her fifties was referred to the outpatient clinic presenting with headache, blurred vision and skin rash. Physical examination with subsequent laboratory and histological examinations revealed severe hyperlipidemia secondary to secretory multiple myeloma with monoclonal IgG kappa protein and erythrocytosis secondary to a erythropoietin secreting adenoma in the liver.


CONCLUSIONS
Treatment for multiple myeloma (induction treatment and autologous hematological stem cell transplantation) gained partial remission and was associated with normalization of serum lipids. There was no need for further medical treatment of the hyperlipidemia. Three years after the initial treatment, serum concentrations of triglycerides and total cholesterol increased in parallel with monoclonal IgG kappa protein. Total cholesterol and triglycerides decreased and remained within the reference ranges after retreatment with a second autologous stem cell transplantation. Surgical removal of the hepatic adenoma caused normalisation of the erythropoietin concentration and resolution of the erythrocytosis. The present case reports two rare complications (AIH and erythrocytosis) to multiple myeloma and hepatic adenoma, with regression of complaints and normalisation of laboratory tests after adequate treatment of underlying diseases.
Hematologisk seksjon, Medisinsk klinikk, Universitetssykehuset Nord-Norge, Norway. anders.vik@unn.no
Anders
A
Vik
Vidar
V
Isaksen
Jan
J
Brox
John-Bjarne
JB
Hansen
D018248:Adenoma, Liver Cell / Q000150:complications* / Q000378:metabolism; D000911:Antibodies, Monoclonal; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications / Q000209:etiology / Q000276:immunology / Q000628:therapy; D004921:Erythropoietin / Q000378:metabolism; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000209:etiology / Q000276:immunology / Q000628:therapy; D007070:Immunoglobulin A; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D011086:Polycythemia / Q000150:complications / Q000209:etiology / Q000378:metabolism / Q000628:therapy
D000911:Antibodies, Monoclonal; D000924:Anticholesteremic Agents; D000970:Antineoplastic Agents; D015525:Fatty Acids, Omega-3; D007070:Immunoglobulin A; D007166:Immunosuppressive Agents; D004921:Erythropoietin