Systemic Amyloidosis and Multiple Myeloma in a Patient with von Willebrand

Abstract

Monoclonal gammopathies encompass a group of disorders that involve the plasmacyte and consequently affect the production of immunoglobulins. Among these gammopathies are systemic amyloidosis and multiple myeloma. These two diseases can coexist in the same patient with a frequency that varies from 13 to 26%, making this association more complex both for the diagnosis and the management of the patients who suffer from them.  We report the case of an elderly male patient with systemic amyloidosis and multiple myeloma in the context of von Willebrand's disease with the aim of encouraging the physician to perform a directed anamnesis identifying the defining symptoms such as bone pain, pathological fractures, renal alteration and bone lesions, defining factors to reach the diagnosis in most cases. In our case the diagnosis was reached based on imaging and immunohistochemical findings of amyloid deposit and presence of plasmacytes with neoplastic phenotype in the bone marrow aspirate.  With initiation of antineoplastic protocol (Bortezomib, Lenalidomide, Dexamethasone) and von willebrand factor supplementation with satisfactory evolution to medical discharge with periodic outpatient follow-up.