Multiple Myeloma Diagnosed from Tongue Amyloidosis: A Case Report

Abstract

Background: Amyloidosis is a metabolic disease of unknown cause and mainly presents with organ damage due to abnormal amyloid deposition. In the oral cavity, it is characterized by macroglossia with a nodule that frequently develops on the tongue. Moreover amyloidosis is often accompanied by multiple myeloma. Herein, we reported a case of multiple myeloma diagnosed from tongue amyloidosis. Case presentation: The patient was a 66-year-old woman who presented to our department with a chief complaint of roughness on the tongue in July 2014. Her tongue was huge and had nodules. Biopsy of the nodule on the right tongue confirmed a definitive diagnosis of amyloidosis. She complained of paresis on the fingers, for which neuropathy due to amyloidosis was suspected. Blood test showed anemia, increased erythrocyte sedimentation rate, decreased serum albumin, and increased serum β2 microglobulin. Immunoelectrophoresis detected the presence of λ-type M protein in the urine and serum. Bone marrow aspiration from the iliac bone led to the definitive diagnosis of multiple myeloma (IgA λ-type, International Staging System stageⅠ) .Lenalidomide, bortezomib, and dexamethasone therapy and autologous peripheral blood stem cell transplantation were administered for multiple myeloma. The treatment effects were “very good partial response” before transplantation and “stringent complete response” after transplantation. As of July 2018, no new nodular formation was seen in the oral cavity, and the general condition was good. Conclusion: When multiple nodules and macroglossia in the tongue are confirmed to be amyloidosis, a systemic search for the possibility of multiple myeloma is important.