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Case Reports
. 2019 Sep 16;11(9):e5669.
doi: 10.7759/cureus.5669.

"D" is for Dilemma

Pirkash Kumar  1 , Carolina Borz-Baba  2 , Sina Raissi  2
Affiliations
Case Reports

"D" is for Dilemma

Pirkash Kumar et al. Cureus. .

Abstract

Immunoglobulin D (IgD) monoclonal gammopathy is a rare subtype of multiple myeloma (MM) associated with a worse prognosis compared with other variants of MM. A 61-year-old man with no known past medical history presented with complaints of abdominal pain, nausea, and vomiting for three weeks. Physical examination revealed mild epigastric tenderness. Laboratory data demonstrated a significantly elevated creatinine with minimal proteinuria and small abnormality in the gamma fraction. Ultrasound of the kidneys described normal-sized kidneys. Serum-free light chains and immunofixation were consistent with IgD kappa monoclonal gammopathy. Kidney biopsy revealed cast nephropathy. Bone marrow biopsy was remarkable for sheets of CD 38+ plasma cells comprising approximately 80% of the marrow cells. Recognizing the atypical presentation of IgD MM is crucial to facilitate early diagnosis and management and improve the prognosis of this subtype of MM.

Keywords: diagnosis; igd multiple myeloma; multiple myeloma; treatment.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT abdomen
CT, computed tomography
Figure 2
Figure 2. Bone marrow biopsy
Figure 3
Figure 3. Renal biopsy
See this image and copyright information in PMC

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