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2nd Edition of International Conference on Gastroenterology

October 21-23, 2024, Baltimore, Maryland, USA

October 21 -23, 2024 | Baltimore, MD, USA
Gastro 2024

Reverse multiple myeloma: First hepatic amyloidosis then multiple myeloma

Speaker at Gastroenterology Conferences - Milaris M Sanchez Cordero
Mayaguez Medical Center, Puerto Rico
Title : Reverse multiple myeloma: First hepatic amyloidosis then multiple myeloma


Multiple myeloma is the most common type of malignant proliferation of plasma cells which produce monoclonal immunoglobulin. Renal failure, anemia, skeletal lesions, and recurrent infections are the most common clinical manifestations of the disease. Amyloidosis is a group of diseases that involve the deposition of amyloidogenic proteins in various organs and can ultimately lead to multiple organ failure. It has been diagnosed in up to 10-15% of multiple myeloma patients with liver involvement in approximately 5% of the cases. This is a case of 48 years old male patient with past medical history of anemia who presented with persistent anemia and transaminitis to his primary care physician. Upon evaluation patient reported several weeks of weakness and malaise with images that showed hepatic heterogeneous parenchymal echotexture. Liver biopsy was performed and resulted with hepatic amyloidosis. Pathology revels hepatic parenchyma with marked deposition of amorphous material withing sinusoids with compression of hepatocytes, positive Congo red stain and negative iron stain; consistent with hepatic amyloidosis. Patient was evaluated and three months later anemia persisted and visited Hematologist and bone marrow was performed that resulted with lambda monotypic plasma cell neoplasm/myeloma approximately 30% on the core biopsy involving a cellular bone marrow. Positive congophilic deposits on the core biopsy consistent with amyloid. Multiple myeloma that develops more than six months after the diagnosis of amyloidosis is very rare and has been shows to have a worse prognosis when combined. The treatment of patients with hepatic involvement can be more challenging. This case highlights the importance to contemplate multiple myeloma as part of the differential diagnosis after amyloidosis findings that could be masked by other common etiologies. Knowledge about this disease is necessary for clinical practice, not only for early detection but for proper management. It is important to know that the disease can relapse and afterwards patients have a very poor prognosis. Infiltrative disorders should be taken into consideration when patients present with non-specific symptoms and impaired liver function tests. For this reason, physicians should also screen patients for these types of malignancies in order to provide a further work up and earlier diagnosis.

Keywords: hepatic amyloidosis, multiple myeloma, congo red stain, bone marrow, liver biopsy.


Dr. Sanchez studied Chemistry at the University of Puerto Rico, Rio Piedras Campus and graduated in 2015. She then started in Medical School in 2016 and finished it in May 2020. As the pandemia arrived, clinical rotations were delayed, and she decided to complete a master’s degree in Autism and Neurodevelopmental Disorders. Then she started in an internship for one year. In 2022 she got accepted in Internal Medicine Residency and is currently a first-year resident. She loved research since was an undergraduate student and participate in several research focused on Prostate Cancer. She is interested in Gastroenterology branch and her plans are to continue in this fellowship.