J Rheum Dis.  2014 Oct;21(5):266-269. 10.4078/jrd.2014.21.5.266.

A Case of Multiple Myeloma Presenting Acute Renal Failure in a Patient with Rheumatoid Arthritis

• Lee SK
• Hwang SH
• Park JH
• Song GW
• Park SY
• Kim SR
• Jung JY
• Bae CB
• Kim HA
• Jeong SH
• Yim HE
• Han JH
• Suh CH

• KMID: 2222952
• DOI: http://doi.org/10.4078/jrd.2014.21.5.266

Abstract

It is known that rheumatoid arthritis (RA) patients show increased incidence of multiple myeloma (MM), despite its rarity. Only one case of MM with seronegative RA was reported in Korea, thus far. We report a case of MM with seropositive RA. The patient was a 66 year old female who had been diagnosed with seropositive RA 4 years ago. Over the last 1 month, the patient experienced general weakness and weight loss of 10 kg. It was found that her serum creatinine had increased and her urine analysis showed proteinuria. To evaluate renal failure and proteinuria, renal biopsy, bone marrow biopsy and electrophoresis were carried out. A diagnosis of myeloma cast nephropathy was made. We report this rare case of MM represented as acute renal failure during the treatment for RA, and include a review of the literature.

Keyword

Rheumatoid arthritis; Multiple myeloma; Acute renal failure; Proteinuria

MeSH Terms

Acute Kidney Injury*
Arthritis, Rheumatoid*
Biopsy
Bone Marrow
Creatinine
Diagnosis
Electrophoresis
Female
Humans
Incidence
Korea
Multiple Myeloma*
Proteinuria
Renal Insufficiency
Weight Loss
Creatinine

Figure

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  Figure 1. Urine Protein electrophoresis shows IgG kappa type monoclonal gammopathy.

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  Figure 2. Renal biopsy shows cast nephropathy. Tubular casts, PAS negative, broken or fractured, are present. Some casts are surrounded by multinucleated giant cells. Glomerulus looks normal (×400).

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  Figure 3. Bone marrow biopsy shows immature and mature plasma cells counted up to 70% (×400).

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  Figure 4. Hand X ray demonstrates bony erosions and periarticular osteopenia on both 2nd and 3rd metacarpophalangeal joints.

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  Figure 5. Lateral radiograph of the skull shows numerous bone lytic lesions which are typical for the appearance of multiple myeloma.

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