IgA kappa chain myeloma with cast nephropathy in a man with type 2 diabetes mellitus and retinopathy

الملخص EN

A 68-year-old gentleman with a long history of type 2 diabetes mellitus and recurrent multidrug resistant urinary tract infection and a recent history of a carbuncle, presented with a one week history of fever and dysuria.

Laboratory results included erythrocyte rouleaux formation, ESR 121 mm / h, creatinine 217umol / l, total protein 83 g / l, albumin 32g / l, and Bence-Jones protein in the urine.

Skull X-ray showed multiple lytic lesions.

Serum protein electrophoresis showed a monoclonal band of 33g / I of IgA kappa, IgG 665 mg / dl, and IgM 26.9 mg / dl.

Bone marrow aspirate showed an infiltration of plasma cells.

Renal biopsy showed a mild cast nephropathy with mild diabetic glomerular disease.

The patient was assessed as stage IIIB multiple myeloma IgA kappa type and was started on chemotherapy MP protocol (oral Melphalan 5 mg / sq m body surface area plus oral prednisolone 60mg/sq m body surface area for four days every four weeks) after which he became stable.