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Severe acute cholestatic hepatitis by infiltration of monoclonal plasma cells in multiple myeloma

C Barth1, A Bosse, T Andus

  • 1Department of Internal Medicine, Gastroenterology, Hepatology and Oncology, Hospital Bad Cannstatt, Klinikum Stuttgart, Germany. c.barth@kbc-intern.de

Zeitschrift Fur Gastroenterologie
|October 13, 2005
PubMed
Abstract

Insights

Multiple myeloma can rarely cause acute liver disease due to plasma cell infiltration. Corticosteroid treatment showed positive results in a patient with this rare presentation.

Area of Science:

  • Hematology
  • Hepatology
  • Oncology

Background:

  • Multiple myeloma, a plasma cell malignancy, affects the liver in 25-40% of patients.
  • Clinical presentation as acute liver disease is rare, often mimicking hepatitis.

Observation:

  • An 88-year-old woman presented with painless jaundice and abnormal liver function tests.
  • Exclusion of viral and autoimmune hepatitis was confirmed.
  • Liver biopsy showed diffuse plasma cell infiltration with lambda light chain restriction.

Findings:

  • Diagnosis of multiple myeloma was confirmed by serological immune fixation (IgG lambda) and bone marrow biopsy.
  • The patient's elevated liver enzymes significantly decreased after prednisolone treatment.

Implications:

  • Hepatic plasma cell infiltration from multiple myeloma can present as acute cholestatic hepatitis.
  • Corticosteroid therapy may be an effective treatment for this rare condition.

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