Rapid improvement of hyperammonemic encephalopathy by bortezomib treatment in IgD-type multiple myeloma.

Abstract

A 74-year-old man visited our hospital with complaints of anorexia, weight loss, and impaired activities of daily living. He presented mild consciousness disturbance at the first visit, but specific causes were identified. The IgD level was>2,000 mg/dl and bone marrow biopsy was performed after aspiration failed due to excessive density. He was diagnosed with IgD/λ multiple myeloma (MM). He lapsed into a coma with an extremely high ammonia level of 484 μg/dl on day 8 after admission. His diagnosis was established as hyperammonemic encephalopathy (HE). He was treated with dexamethasone (Dex) pulse therapy and continuous hemodiafiltration. Minor improvement of hyperammonemia was achieved. Combination therapy with bortezomib and Dex was commenced. His ammonia level rapidly decreased and his mental state improved. HE accompanied by MM is rare and further studies are needed to clarify outcomes in response to treatment using the novel agent Bor. Although HE is potentially fatal, we found Bor to be rapidly effective against HE.

• Authors: Maiko Esaki, Kazuyoshi Ishii, Yoshiko Azuma, Yukie Tsubokura, Hideaki Yoshimura, Masaaki Hotta, Takahisa Nakanishi, Shinya Fujita, Aya Nakaya, Atsushi Satake, Tomoki Ito, Shosaku Nomura
• Journal: [Rinsho ketsueki] The Japanese journal of clinical hematology (Rinsho Ketsueki) Vol. 57 Issue 7 Pg. 854-8 (07 2016) ISSN: 0485-1439 [Print] Japan
• PMID: 27498728 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antineoplastic Agents
• Immunoglobulin D
• Bortezomib

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Bortezomib (therapeutic use)
• Brain Diseases (etiology)
• Humans
• Hyperammonemia (etiology)
• Immunoglobulin D (immunology)
• Male
• Multiple Myeloma (complications, drug therapy, immunology)