Refractory multiple myeloma with impaired consciousness accompanied by hyperammonemia and leukoencephalopathy-like findings

DOI Web Site PubMed
  • KONUMA Hikari
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • AOTA Yasuo
    Department of Internal Medicine, Kohsei Chuo General Hospital Department of Hematology, Juntendo University School of Medicine
  • UDAGAWA Shohei
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • HONDA Tadahiro
    Department of Internal Medicine, Kohsei Chuo General Hospital Department of Hematology, Juntendo University School of Medicine
  • OKUDA Yuko
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • IWAI Tetsu
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • SUJINO Hiroki
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • TAKAHASHI Maya
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • KITAGAWA Naoyuki
    Department of Internal Medicine, Kohsei Chuo General Hospital
  • GOTOH Akihiko
    Department of Internal Medicine, Kohsei Chuo General Hospital Department of Hematology, Juntendo University School of Medicine Department of Hematology, Tokyo Medical University School of Medicine

Bibliographic Information

Other Title
  • 高アンモニア血症および白質脳症様画像所見を伴う意識障害を認めた治療抵抗性多発性骨髄腫
  • 症例報告 第11回日本血液学会関東甲信越地方会 優秀演題 高アンモニア血症および白質脳症様画像所見を伴う意識障害を認めた治療抵抗性多発性骨髄腫
  • ショウレイ ホウコク ダイ11カイ ニホン ケツエキ ガッカイ カントウ コウシンエツチホウカイ ユウシュウ エンダイ コウアンモニア ケッショウ オヨビ ハクシツ ノウショウ ヨウ ガゾウ ショケン オ トモナウ イシキ ショウガイ オ ミトメタ チリョウ テイコウセイ タハツセイ コツズイシュ

Search this article

Abstract

<p>A 81-year-old female was diagnosed with symptomatic multiple myeloma (MM; IgG κ type, D&S: IIB, ISS: 2) in August 2017. Although treatment with lenalidomide and dexamethasone was started, she developed deep venous thrombosis in the lower extremities as a complication; therefore, the treatment was changed to DBd. In February 2018, she required hospitalization due to general weakness and altered consciousness. Her IgG level and κ/λ ratio were elevated at 4,156 mg/dl and 605.56, respectively, revealing that MM was treatment-resistant. A protein-cell dissociation (cell blood count, 0/µl; protein, 100.6 mg/dl) was detected in the cerebrospinal fluid, whereas the ammonia level in serum was high (172 µg/dl). T2-weighted magnetic resonance imaging showed a broad range of high-density area in deep cerebral white matter suggesting leukoencephalopathy, whereas the cerebrospinal fluid was negative for JC virus. No pathological conditions causing secondary hyperammonemia were found. Although the involvement of drug-induced leukoencephalopathy in altered consciousness could not be ruled out since the chromosome with the normal karyotype at the first visit had a complex chromosomal abnormality, an originally minor clone of MM cells with a chromosomal abnormality might have contributed to the ammonia production resulting in altered consciousness.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 61 (3), 234-239, 2020

    The Japanese Society of Hematology

Keywords

Details 詳細情報について

Report a problem

Back to top