PMID- 18163912
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20110714
LR  - 20181113
IS  - 1752-1947 (Print)
IS  - 1752-1947 (Electronic)
IS  - 1752-1947 (Linking)
VI  - 1
DP  - 2007 Dec 29
TI  - Light chain deposition disease presenting as paroxysmal atrial fibrillation: a 
      case report.
PG  - 187
LID - 10.1186/1752-1947-1-187 [doi]
AB  - INTRODUCTION: Light chain deposition disease (LCDD) can involve the heart and 
      cause severe heart failure. Cardiac involvement is usually described in the 
      advanced stages of the disease. We report the case of a woman in whom restrictive 
      cardiomyopathy due to LCDD presented with paroxysmal atrial fibrillation. CASE 
      PRESENTATION: A 55-year-old woman was admitted to our emergency department 
      because of palpitations. In a recent blood test, serum creatinine was 1.4 mg/dl. 
      She was found to have high blood pressure, left ventricular hypertrophy and 
      paroxysmal atrial fibrillation. An ACE-inhibitor was prescribed but her renal 
      function rapidly worsened and she was admitted to our nephrology unit. On 
      admission serum creatinine was 9.4 mg/dl, potassium 6.8 mmol/l, haemoglobin 7.7 
      g/dl, N-terminal pro-brain natriuretic peptide 29894 pg/ml. A central venous 
      catheter was inserted and haemodialysis was started. She underwent a renal biopsy 
      which showed kappa LCDD. Bone marrow aspiration and bone biopsy demonstrated 
      kappa light chain multiple myeloma. Echocardiographic findings were consistent 
      with restrictive cardiomyopathy. Thalidomide and dexamethasone were prescribed, 
      and a peritoneal catheter was inserted. Peritoneal dialysis has now been 
      performed for 15 months without complications. DISCUSSION: Despite the 
      predominant tubular deposition of kappa light chain, in our patient the first 
      clinical manifestation of LCDD was cardiac disease manifesting as atrial 
      fibrillation and the correct diagnosis was delayed. The clinical management 
      initially addressed the cardiovascular symptoms without paying sufficient 
      attention to the pre-existing slight increase in our patient's serum creatinine. 
      However cardiac involvement is a quite uncommon presentation of LCDD, and this 
      unusual case suggests that the onset of acute arrhythmias associated with 
      restrictive cardiomyopathy and impaired renal function might be related to LCDD.
FAU - Fabbian, Fabio
AU  - Fabbian F
AD  - Renal Unit, St, Anna Hospital, Ferrara, Italy. hrfabbia@tin.it.
FAU - Stabellini, Nevio
AU  - Stabellini N
FAU - Sartori, Sergio
AU  - Sartori S
FAU - Tombesi, Paola
AU  - Tombesi P
FAU - Aleotti, Arrigo
AU  - Aleotti A
FAU - Bergami, Maurizio
AU  - Bergami M
FAU - Uggeri, Simona
AU  - Uggeri S
FAU - Galdi, Adriana
AU  - Galdi A
FAU - Molino, Christian
AU  - Molino C
FAU - Catizone, Luigi
AU  - Catizone L
LA  - eng
PT  - Journal Article
DEP - 20071229
PL  - England
TA  - J Med Case Rep
JT  - Journal of medical case reports
JID - 101293382
PMC - PMC2254633
EDAT- 2008/01/01 09:00
MHDA- 2008/01/01 09:01
PMCR- 2007/12/29
CRDT- 2008/01/01 09:00
PHST- 2007/06/21 00:00 [received]
PHST- 2007/12/29 00:00 [accepted]
PHST- 2008/01/01 09:00 [pubmed]
PHST- 2008/01/01 09:01 [medline]
PHST- 2008/01/01 09:00 [entrez]
PHST- 2007/12/29 00:00 [pmc-release]
AID - 1752-1947-1-187 [pii]
AID - 10.1186/1752-1947-1-187 [doi]
PST - epublish
SO  - J Med Case Rep. 2007 Dec 29;1:187. doi: 10.1186/1752-1947-1-187.