Splenic rupture and osteolysis due to primary amyloidosis

A 51-year-old woman consulted the emergency department for a 13 kg weigth loss and acute epigastric pain, , anemia and renal failure (creatinine 5.9 mg / dL) with metabolic acidosis. An abdominal CT scan without iv contrast showed possible subcapsular hemorrhage; and diffuse osteolytic lesion of the sacrum and adjacent iliacs. After support treatment, it was stabilized clinically, so an expectant attitude was decided on by Surgery. In the following days, complementary tests were performed, highlighting: light chains kappa 564 mg / L, kappa / lambda 33.7. Therefore, an iliac crest biopsy was performed on affected bone and the spinal aspirate showed abundant cellularity, plasmacytosis of 9-10%. After one week, she presented diffuse abdominal pain and underwent a laparotomy that showed splenic rupture and hemoperitoneum. The anatomopathological study of spleen and bone reported infiltration by Congo Red (+) material, diagnostic of splenic and medullary amyloidosis.