Symptomatic multiple myeloma diagnosed as a result of elevated intracircuit pressure during dialysis

Abstract

The patient was a 72-year-old man with a history of diabetic glomerulosclerosis, diagnosed 16 years prior to admission at a different hospital during an investigation for nephrotic syndrome. At the same time, monoclonal gammopathy of undetermined significance (MGUS) was also identified based on positive findings for M protein and urinary Bence-Jones protein (BJP). However, the patient’s hematology outpatient visits were suspended. Dialysis was initiated 8 years previously, but he was subsequently referred to our department because of intra-circuit coagulation during dialysis. The patient was diagnosed with symptomatic myeloma (MM) with increased M protein (IgG-λ) and bone marrow plasma cells. Daratumumab + bortezomib + dexamethasone therapy was initiated; however, this treatment resulted in persistent escalated pressure on dialysis due to hyperviscosity syndrome (HVS). Consequently, plasma exchange was initiated. The dialysis complications experienced by the patient resolved after the administration of isatuximab + pomalidomide + dexamethasone therapy, which led to a reduction in his M-protein levels. HVS is a rare complication of MM (2–6%) and it is associated with high M-protein levels and high serum viscosity. This case was noteworthy because the patient was diagnosed with MM due to dialysis difficulties associated with HVS.