Multiple Myeloma

Clinical History

This 70-year old retired storeman presented to his LMO with low back pain, sensory loss in both hands in the distribution of the median nerve, weakness and severe dyspnoea. FBE showed a Hb of 12.8 g% with rouleaux formation on the film. ESR was raised at 50 mm/hr. Total plasma protein was elevated with a "spike" in the IgG region on electrophoresis. Bone marrow biopsy confirmed a diagnosis of multiple myeloma. The patient was commenced on treatment but died from severe heart failure 9 months later.

Pathology

This is a specimen of heart cut transversely at the mid-ventricular level, and stained with Congo Red. Both ventricles are dilated but there is little hypertrophy present. Numerous pink staining deposits are seen in the myocardium. This is an example of amyloidosis of the heart. Amyloidosis is a well recognised complication of multiple myeloma. Cardiac amyloidosis may cause restrictive cardiomyopathy, however, this is not a common complication of multiple myeloma.