A Case of Light Chain Deposition Disease Leading to Acute Liver Failure and Review of Literature

Abstract

Light chain deposition disease (LCDD) is a monoclonal immunoglobulin deposition disease characterized by light chain deposition in soft tissues and viscera, causing systemic organ dysfunction with an underlying lymphoproliferative disorder. While the kidney is the most affected organ, cardiac and hepatic involvement is also seen with LCDD. Hepatic manifestation can range from mild hepatic injury to fulminant liver failure. Herein, we are presenting a case of an 83-year-old woman with a monoclonal gammopathy of undetermined significance (MGUS), who presented to our institution with acute liver failure progressing to circulatory shock and multiorgan failure. After an extensive workup, a diagnosis of hepatic LCDD was determined. In conjunction with the hematology and oncology department, chemotherapy options were discussed, but given her poor prognosis, the family decided to pursue a palliative route. Though establishing a prompt diagnosis is important for any acute condition, the rarity of this condition, along with paucity of data, makes timely diagnosis and treatment challenging. The available literature shows variable rates of success with chemotherapy for systemic LCDD. Despite chemotherapeutic advances, liver failure in LCDD indicates a dismal prognosis, where further clinical trials are difficult owing to the low prevalence of the condition. In our article, we will also be reviewing previous case reports on this disease.

Vitamin C Deficiency as a Mimicker of a Coagulation Disorder

“…Despite its history as an archaic maritime disease,1 scurvy continues to plague patients with inadequate nutrition, excessive alcohol use, certain gastrointestinal (GI) diseases and cancer 1–3. In fact, in the USA, about 8.4% of adults are estimated to have some degree of vitamin C deficiency 4…”

“…When vitamin C deficiency is severe, scurvy can result. Since our bodies cannot synthesise vitamin C, it must be acquired through diet or supplementation 1–3. When vitamin C is consumed in the form of fruits and vegetables, it is primarily absorbed through active transport via the sodium vitamin C cotransporter in the distal ileum 3.…”

“…When vitamin C is consumed in the form of fruits and vegetables, it is primarily absorbed through active transport via the sodium vitamin C cotransporter in the distal ileum 3. Vitamin C is needed for various physiological processes, including collagen synthesis and assembly, iron absorption, antioxidant function and hormone synthesis 1–3…”

“…Scurvy classically presents with swollen and bleeding gums, petechiae, ecchymoses, anaemia, impaired wound healing, myalgias and arthralgias 1 3 4. If left untreated, scurvy can be fatal due to myocardial or cerebral haemorrhage 3 4.…”

“…If left untreated, scurvy can be fatal due to myocardial or cerebral haemorrhage 3 4. Due to the haematological abnormalities it causes, it may mimic other diseases, including vasculitides, malignancies and rheumatological conditions 1 3. While scurvy does involve excess bleeding, it is not known to cause blood clotting.…”