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Case report: multiple myeloma presenting as a diastolic heart failure with no evidence of amyloidosis
A Schattner1, M Epstein, A Berrebi
1Division of Medicine, Kaplan Hospital, Rehovot, Israel.
Insights
Severe congestive heart failure revealed immunoglobulin G (lambda) myeloma. Myocardial infiltration, not amyloid, caused severe diastolic dysfunction in both ventricles, a rare presentation of immunoglobulin deposition disease.
Area of Science:
- Cardiology
- Hematology
- Pathology
Background:
- Congestive heart failure can be a manifestation of various systemic diseases.
- Immunoglobulin deposition disease (IDD) is a rare condition characterized by the deposition of immunoglobulin light chains in organs.
Observation:
- A patient presented with severe right-sided congestive heart failure.
- Diagnostic workup revealed immunoglobulin G (lambda) myeloma with light chain predominance.
Findings:
- Cardiac catheterization and endomyocardial biopsy demonstrated severe biventricular diastolic dysfunction.
- Extensive myocardial infiltration by intercellular fibrillar tissue, confirmed as not amyloid, was observed.
Implications:
- This case highlights a rare presentation of immunoglobulin deposition disease associated with immunocytic dyscrasias.
- Early recognition and diagnosis are crucial for managing cardiac complications in myeloma patients.
Abstract:
The development of severe right sided congestive heart failure led to a diagnosis of immunoglobulin G (lambda) myeloma with a predominance of light chains. Cardiac catheterization and endomyocardial biopsy showed a severe diastolic dysfunction of both right and left ventricles and extensive myocardial infiltration by intercellular fibrillar tissue, which was not amyloid. This is a rare presentation of immunoglobulin deposition disease associated with immunocytic dyscrasias.