title: Myeloma-associated systemic amyloidosis masquerading as NASH-associated cirrhosis and diabetic microvascular complications.
abstract: Authors describe the case of a 60-year-old diabetic man who presented with jaundice, ascites and significant weight loss over a period of 2 months. Physical examination revealed firm hepatomegaly with ascites. On evaluation, nephropathy, axonal neuropathy, carpal tunnel syndrome and decompensated cryptogenic liver disease with portal hypertension were found fitting with the diagnosis of diabetic nephropathy and neuropathy and nonalcoholic steato-hepatitis-associated cirrhosis, respectively. It was only after tissue diagnosis and serum protein electrophoresis that a definitive diagnosis of myeloma-related amyloidosis was made. This case emphasizes the fact that due to nonspecific initial presentation and multisystem involvement, a high index of suspicion and prompt use of appropriate tests including tissue diagnosis may be required to diagnose amyloid light-chain amyloidosis, which may be a rare presenting feature of myeloma. It should be differentiated from a commoner multisystem disease like diabetes and its complications.
authors.affiliation: Department of General Medicine , Calcutta National Medical College and Hospital , Kolkata, West Bengal , India.
authors.forename: Partha
authors.initials: P
authors.lastname: Pal
authors.affiliation: Department of Endocrinology and Metabolism , Institute of Post Graduate Medical Education & Research (IPGMER) and SSKM Hospital , Kolkata, West Bengal , India.
authors.forename: Sayantan
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Pathology , Calcutta National Medical College and Hospital , Kolkata, West Bengal , India.
authors.forename: Sisir Kumar
authors.initials: SK
authors.lastname: Patra
authors.affiliation: Department of Pathology , Calcutta National Medical College and Hospital , Kolkata, West Bengal , India.
authors.forename: Anjan Kumar
authors.initials: AK
authors.lastname: Das
authors.affiliation: Department of General Medicine , Calcutta National Medical College and Hospital , Kolkata, West Bengal , India.
authors.forename: Subhasis
authors.initials: S
authors.lastname: Dey
authors.affiliation: Department of General Medicine , Calcutta National Medical College and Hospital , Kolkata, West Bengal , India.
authors.forename: Rintu
authors.initials: R
authors.lastname: George