Abstract | April 4, 2022

Unusual presentation of amyloidosis as pelvic pseudo-tumor: A case report

Presenting Author: Olaniyi Fadeyi, MD, Internal Medicine PGY 2, Department of Internal Medicine, West Anaheim Medical Center, Anaheim, California

Coauthors: Ali A. Esmaeili, MD, Internal Medicine, PGY 1, West Anaheim Internal Medicine Program, Anaheim, CA; Phoung Nguyen, DO, Internal Medicine, PGY 3, West Anaheim Internal Medicine Program, Anaheim, CA; Hakim Asaad, MD, Internal Medicine Faculty, West Anaheim Internal Medicine Program, Anaheim, CA

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to identify the need to rule out systemic amyloidosis in patient presenting with multiple myeloma-like symptoms.

Multiple myeloma is caused by abnormal proliferation of plasma cells in the bone marrow. Most patients tend to present with hypercalcemia, renal failure, anemia and bone pain. Multiple myeloma has been associated with AL amyloidosis in rare cases. AL amyloidosis is the most common type of systemic amyloidosis which is often associated with plasma cell disorder. It usually affects the kidney and heart. Patients with AL amyloidosis could however present with vague symptoms which makes it challenging to quickly diagnose the disease.

We therefore report a case of a 59-year-old female without any significant past medical history who presented to the ED with complaints of back pain, abdominal pain, lower extremity weakness, nausea and vomiting. Labs revealed low hemoglobin, elevated protein and high creatinine. In addition, serology markers of myocardial injury were significant for elevated troponin and BNP. CT chest, abdomen and pelvis without contrast showed soft tissue mass involving the sacrum along with multiple lytic lesions involving the thoracic and lumbar spine. Biopsy result for the mass was consistent with amyloidosis without any evidence of malignant cells. Bone marrow biopsy with flow cytometry revealed 90% plasma cells. Peripheral blood smear showed rouleaux formation. SPEB was significant for M-spike.

The patient was diagnosed with multiple myeloma secondary to amyloidosis. She was started on high pulse dexamethasone, cyclophosphamide and bortezomib. Our case further reinforces the need for early work-up for AL amyloidosis in patients who present with unexplained proteinuria, neuropathy, cardiomyopathy and multiple myeloma-like symptoms.

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