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[Light chain multiple myeloma revealed by an amyloid arthropathy. A report of two cases]
1Service de rhumatologie, hôpital La-Rabta, Tunis, Tunisie. rhumatologie2004@yahoo.fr
Introduction:
Amyloid arthropathy occurs in 5-15% of patients with multiple myeloma. It is rarely inaugural. Some cases are reported in which the articular manifestations are present many months before the diagnosis of myeloma. We report two unusual cases where the amyloid arthropathy reveals the multiple myeloma.
Exegesis:
Case 1: A 54-year-old man take medical advice for a polyarthritis evolving for 6 months. He has no evidence of multiple myeloma except a hypercalcemia and a hypoalbuminemia. The diagnosis of multiple myeloma is based on an immunobinding of plasmatic proteins. It is a light chain multiple myeloma, lambda type. Amylosis is revealed by biopsy specimens from the synovial tissue of the knee. The patient died rapidly because of an intestinal hemorrhage. Case 2: A 78-year-old woman complains from a polyarthritis evolving for 4 months. She has besides an elevated erythrocyte sedimentation rate, an anemia and a renal insufficiency, a profound hypogammaglobulinemia. There is no radiological abnormalities. The diagnosis of multiple myeloma is based on serum and urine immunoelectrophoresis. It is a light chain multiple myeloma, lambda type. The patient is at her sixth monthly course of cyclophosphamid and prednisone. As far as amyloid arthropathy is concerned, it is relatively improved by corticoid intra-articular injections.
Conclusion:
These are two case reports of a light chain multiple myeloma of lambda type, associated to an amyloid arthropathy in its polyarticular presentation, mimicking a rheumatoïd arthritis. The revelatory nature of the amyloid arthropathy is interesting to report.
Insights
Amyloid arthropathy, a rare presenting symptom of multiple myeloma, was observed in two unusual cases of light chain multiple myeloma (lambda type). This condition mimicked rheumatoid arthritis, highlighting the diagnostic challenge.
Area of Science:
- Rheumatology
- Hematology
- Oncology
Background:
- Amyloid arthropathy affects 5-15% of multiple myeloma patients, but rarely presents as the initial symptom.
- Articular manifestations can precede multiple myeloma diagnosis by months.
- This report details two unique cases where amyloid arthropathy revealed underlying multiple myeloma.
Observation:
- Case 1: A 54-year-old man presented with a 6-month history of polyarthritis, hypercalcemia, and hypoalbuminemia, later diagnosed with lambda light chain multiple myeloma.
- Case 2: A 78-year-old woman experienced a 4-month polyarthritis with anemia, renal insufficiency, and hypogammaglobulinemia, diagnosed with lambda light chain multiple myeloma.
- Both cases featured polyarticular amyloid arthropathy mimicking rheumatoid arthritis.
Findings:
- Diagnosis of multiple myeloma was confirmed via protein immunofixation and immunoelectrophoresis in both patients.
- Amyloidosis was histologically confirmed by synovial tissue biopsy in Case 1.
- Both patients had lambda light chain multiple myeloma, a subtype associated with amyloidosis.
Implications:
- Amyloid arthropathy can be an inaugural manifestation of multiple myeloma, necessitating thorough hematological evaluation.
- Early recognition of amyloid arthropathy in the context of polyarthritis is crucial for timely multiple myeloma diagnosis.
- These cases underscore the importance of considering systemic diseases in patients presenting with atypical arthropathies.
