From monoclonal gammapathy of undetermined significance (MGUS) to plasma cell myeloma and amyloidosis — a case report
Abstract
We present a 69-year-old patient, in whom in March 2016 a monoclonal gammopathy of undetermined
significance (MGUS) was diagnosed. The disease was found during the diagnostics of
thrombocytopenia (from 2009 the number of platelets varied between 90–140 G/l). In serum immunofixation
assay the presence of monoclonal IgG kappa protein was confirmed. In July 2017,
when the patient presented with nephrotic syndrome and acute renal failure, 14.5% of plasma
cells were found in the bone marrow. Moreover, a biopsy of abdominal fat revealed the presence of
amyloid composed of kappa light chains. The diagnosis of IgG kappa plasma cell myeloma (PCM)
complicated with amyloidosis of the kidneys, heart, liver and spleen was established. The PCM progression
complicated with amyloidosis was very aggressive. Despite the treatment with bortezomib
and dexamethasone the patient died early. Sudden deterioration of health (e.g. in the form of acute renal failure) in a patient with MGUS may indicate not only the progression of MGUS to PCM, but
also the development of amyloidosis, which is associated with turbulent disease and poor prognosis.
Keywords: MGUSplasma cell myelomaamyloidosis
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