IgD lambda multiple myeloma causing hyperammonaemia with possibly reduced ammonium excretion.
Naohi Isse1, Kei Nakahara2, Ryutaro Sasai3
1General Medicine, Okayama Kyoritsu General Hospital, Okayama, Okayama, Japan issenaohi@yahoo.co.jp.
BMJ Case Reports
|July 20, 2022
Summary
A rare case of multiple myeloma caused severe hyperammonaemia in an elderly man. Chemotherapy improved his condition, but the underlying disease led to a fatal outcome.
Area of Science:
- Nephrology
- Oncology
- Hematology
Background:
- Multiple myeloma is a plasma cell malignancy.
- Hyperammonaemia is a serious condition characterized by elevated ammonia levels in the blood.
- The association between multiple myeloma and hyperammonaemia is rare and not fully understood.
Observation:
- An elderly male patient presented with impaired consciousness due to hyperammonaemia.
- The patient had multiple tumors and was diagnosed with immunoglobulin D lambda multiple myeloma.
- No other causes for hyperammonaemia were identified.
Findings:
- Chemotherapy with bortezomib, dexamethasone, and daratumumab led to improved consciousness and normalized ammonia levels.
- Autopsy revealed lambda light-chain deposits in renal tubules, suggesting a potential mechanism for hyperammonaemia.
- Urine analysis indicated reduced urinary ammonium excretion, possibly linked to renal pathology.
Implications:
- This case highlights a rare but severe complication of multiple myeloma.
- Renal pathology, specifically light-chain deposition, may play a role in hyperammonaemia in multiple myeloma patients.
- Further research is needed to understand the renal contribution to hyperammonaemia in multiple myeloma.
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