PMC6512067_01
CT image prior to carfilzomib administration. (a) Low uptake throughout the entire liver and splenomegaly could be observed. (b) Para-aortic lymph node swelling was observed (red arrow).
CRIHEM2019-1816287.001.jpg
PMC6512067_01_CRIHEM2019-1816287.001.jpg
fig1
CT revealed extramedullary tumor in the para-aortic region, which was thought to indicate disease progression, in addition to low uptake throughout the entire liver (Figure 1).
Transthoracic echocardiography beforeand after carfilzomib. After the administration of carfilzomib, the left ventricular ejection fraction decreased to 28% with diffuse wall motion abnormalities, particularly the anteroseptal segment.
CRIHEM2019-1816287.002.jpg
PMC6512067_01_CRIHEM2019-1816287.002.jpg
fig2
Ejection fraction (EF) reduced from 59% to 28% (Figure 2), and radiography revealed pulmonary congestion with pleural effusions.
Pathological autopsy findings. (a) Bone marrow contained large basophilic cells with perinuclear halo and proliferation of large cells with distinct nucleoli, which were positive for IgA on immunostaining. (b, c) In the kidneys, the distal convoluted and collecting tubules were filled with eosinophilic amorphous deposits, which was positive for kappa light chain. (d, e, f) Fibrosis and disarray were observed between the myocardial cells, and these myocardial cells showed basophilic degeneration. Invaded inflammatory cells were positive for CD3 but negative for CD79a.
CRIHEM2019-1816287.003.jpg
PMC6512067_01_CRIHEM2019-1816287.003.jpg
fig3
Pathological findings of the bone marrow showed basophilic cells with an eccentric nucleus and proliferation of large cells, which were positive for IgA on immunostaining (Figure 3(a)). The distal convoluted and collecting tubules were filled with eosinophilic amorphous deposits, which was positive for kappa light chain (Figures 3(b) and 3(c)). Between the myocardial cells, fibrosis and disarray were observed (Figures 3(d)-3(f)).