JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
CLINICAL CASE OF THE MONTH
Abstracts from the 2018 Annual Louisiana American College of Physicians (ACP) Associates Meeting Each year medical students from the four medical schools and residents from the eight Internal Medicine training programs in Louisiana are invited to submit abstracts for the Annual Louisiana American College of Physicians (ACP) Associates Meeting. The content of these abstracts includes clinical case vignettes or research activities. The abstracts have all identifying features removed (i.e., names, institutional affiliations, etc.) before being sent to physician judges. Each judge scores each abstract independently and then the scores from all judges are averaged and ranked. This year we are excited to be able to publish the 15 most highly ranked abstracts presented at this year’s competition that were oral presentations. Additionally 12 abstracts (out of 57 total) were selected by meeting attendees for publication. All abstracts (15 oral and 12 poster) were presented at the Associates Meeting held at University Medical Center in New Orleans on January 23, 2018. We would like to thank the Journal of the Louisiana State Medical Society and appreciate its efforts to publicize the hard work of these trainees.
Shane Sanne, DO Chair, Louisiana Associates Liaison Committee
Lee S. Engel, MD, PhD, FACP Governor, Louisiana Chapter ACP
A CASE OF MULTIPLE MYELOMA PRESENTING WITH AMYLOID ASSOCIATED MYOPATHY
anemia, hypoalbuminemia, and significant proteinuria, but no hypercalcemia or renal insufficiency. Subsequent serum and urine protein electrophoresis showed prominent lambda chains in the urine with additional IgG lambda monoclonal protein in the serum and urine. Skeletal survey showed early lytic bone lesions. She underwent bone marrow biopsy that demonstrated increased plasma cells at 70% consistent withmultiplemyeloma. This did not completely explain her isolated left extremity weakness so amyloid infiltration was considered. Congo red stain was later performed on the same specimen, which confirmed amyloid deposition within the blood vessel walls. Treatment was initiated with dexamethasone, lenalidomide and bisphosphonates, resulting in improvement of her symptoms. Discussion : This case illustrates the important clinical and laboratory findings associated with multiple myeloma, and describes an uncommon complication, amyloidosis, resulting in profound myopathy. Classic presentation typically includes CRAB features (hypercalcemia, renal insufficiency, anemia, and bone pain). However, variable initial clinical findings and the absence of typical lab markers can make recognition of the disorder difficult in many patients. Amyloid myopathy should be a consideration in adults with muscular weakness of uncertain cause. Late diagnosis remains a major obstacle to initiating effective therapy. Hence recognizing the presenting syndromes is necessary for improving survival.
J Manalac, MD; G. Jacob, MD; K. Raybon, MD Department of Internal Medicine, LSU Health Sciences Center - Lafayette *Presented as a mystery case
Introduction : Amyloidosis-associated myopathy is rare. Delay in diagnosis is common and there is a high rate of pathologic and clinical misdiagnosis. Case : A 58-year-old woman presented to the hospital with acute onset, profound left lower extremity weakness and pain. She had no prominent constitutional symptoms except for generalized tiredness and weakness. On physical examination, she had mild temporal wasting, impressive left hip and knee extensor weakness, left pitting pedal edema, and good vascular perfusion. No other focal neurologic deficits were noted. She underwent extensive evaluation including comprehensive CT imaging of the lumbar spine, abdomen and pelvis that demonstrated diffuse enlargement of the musculature and a heterogeneous appearing left iliacus muscle with hypodense areas, concerning for inflammatory or infectious myositis. A diagnosis of inflammatory myositis was unlikely due to normal CPK and aldolase levels. She was initially treated with IV antibiotics for presumed pyomyositis without improvement. Furthermore, routine laboratory evaluation revealed mild
54 J La State Med Soc VOL 170 MARCH/APRIL 2018
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