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From question on page 1376

The diagnosis was light chain deposition disease (LCDD) involving the liver.

LCDD is a rare complication of multiple myeloma occurring in only 5% of cases. Renal involvement is the most common complication of LCDD and usually dominates the clinical course. The liver is involved in at least 23% of cases but rarely affects clinical outcome. The case presented is unusual for the predominant hepatic involvement and the fact that it predated clinically significant renal disease. It is important to note however that the patient did ultimately develop acute renal failure and this more likely accounted for the noted encephalopathy than acute liver failure or portosystemic shunting. Review of the liver biopsy revealed eosinophilic material lining the sinusoids, hepatic arteries, and hepatic veins in a linear pattern. The deposits were negative for Congo red, positive for the Masson trichrome, and PAS positive diastase resistant. Immunostaining was strongly positive for κ but negative for λ light chains, leading to a diagnosis of κ LCDD. LCDD is an important diagnostic consideration in all patients with myeloma who present with renal or hepatic impairment. While other causes such as drug toxicity, infection, and amyloidosis must be excluded, LCDD should be considered and the appropriate stains performed, otherwise it may be overlooked.

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