[A rare case of cholestasis and macrohematuria in a 52-year-old patient]

Abstract

Clinical symptoms: We report of a 52-year-old man from Egypt who suffered from 20 kg weight loss within 6 months, jaundice, macrohematuria, and impaired renal function.

Investigations and therapy: Due to the ultrasound and the CT scan of the abdomen, a kidney tumor was suspected. A nephrectomy was planned but the biopsy of the kidney and liver intraoperatively revealed amyloid deposits. A plasma cell dyscrasia of 15% was found by bone marrow biopsy. Immunfixation showed an IgG-kappa light chain in plasma and urine. There was no osteolysis throughout the skeletal system. Thus, the patient had a plasmacytoma Stage II associated with IgG-kappa light chain AL-amyloidosis which was treated by chemotherapy (melphalan and prednisolone).

Conclusion: This unusual case presents a cholestatic liver disease due to bile duct obstruction secondary to amyloid deposits. Although AL-amyloidosis is easily diagnosed by certain criteria, the disease is often recognized too late with consequently poor prognosis.