World J Gastroenterol. Apr 28, 2009; 15(16): 2038-2040 Published online Apr 28, 2009. doi: 10.3748/wjg.15.2038
Hepatic failure caused by plasma cell infiltration in multiple myeloma
Fadi E Rahhal, Robert R Schade, Asha Nayak, Teresa A Coleman
Fadi E Rahhal, Robert R Schade, Section of Gastroenterology, Department of Medicine, Medical College of Georgia, School of Medicine, Augusta, GA 30912, United States
Asha Nayak, Teresa A Coleman, Section of Hematology/Oncology, Department of Medicine, Medical College of Georgia, School of Medicine, Augusta, GA 30912, United States
Author contributions: Rahhal FE, Schade RR, Nayak A and Coleman TA contributed equally to this work.
Correspondence to: Fadi E Rahhal, MD, Section of Gastroenterology, Department of Medicine, Medical College of Georgia, 1120 15th street, Augusta, Georgia 30912, United States. fadirahhal@yahoo.com
Telephone: +1-706-7212238
Fax: +1-706-7210331
Received: January 13, 2009 Revised: March 20, 2009 Accepted: March 27, 2009 Published online: April 28, 2009
Abstract
Although plasma cell infiltration is not rare in autopsy of patients with multiple myeloma (MM), it is very rarely detected in living patients. This is because MM rarely causes significant liver dysfunction that requires further evaluation. A 49-year-old man presented with acute renal failure and was diagnosed with kappa light chain MM stage IIB. Thalidomide and dexamethasone were initiated. The patient developed a continuous increase in bilirubin that led to severe cholestasis. A liver biopsy revealed plasma cell infiltration. He then rapidly progressed to liver failure and died. Treatment options are limited in MM with significant liver dysfunction. Despite new drug therapies in MM, those patients with rapidly progressive liver failure appear to have a dismal outcome.
