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κ Light-chain monoclonal gammopathy and cast nephropathy in a horse with multiple myeloma

Christina EberhardtEquine Department, Clinic for Equine Internal Medicine, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland.

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Alexandra MalbonInstitute for Veterinary Pathology, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland.

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Barbara RiondClinical Laboratory, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland.

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Angelika SchosterEquine Department, Clinic for Equine Internal Medicine, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland.

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Abstract

CASE DESCRIPTION A 27-year-old Dutch Warmblood mare was evaluated because of a history of lethargy, reluctance to move, weight loss, persistent hyperproteinemia, and recurrent episodes of mild lameness.

CLINICAL FINDINGS Hematologic evaluation revealed anemia (RBC concentration, 3.84 × 106 cells/μL), thrombocytopenia (47 × 103 thrombocytes/μL), and hyperproteinemia (total protein concentration, 11.2 g/dL) with hyperglobulinemia and hypoalbuminemia. Results of protein electrophoresis of serum and urine samples indicated a monoclonal gammopathy; the paraprotein was identified as a κ light chain. On abdominal ultrasonographic examination, hypoechoic nodules were visualized in the spleen. Results of cytologic examination of a splenic fine-needle aspirate and histologic examination of a bone marrow biopsy sample were consistent with plasma cell myeloma.

TREATMENT AND OUTCOME Treatment was declined owing to the age of the horse and poor prognosis. The horse was discharged from the hospital, and the owner was given palliative care instructions. The horse was euthanized 2 weeks later because of recurrent episodes of lethargy, anorexia, and signs of colic. Necropsy confirmed the diagnosis of multiple (plasma cell) myeloma. Plasma cell aggregates in the liver, spleen, bone marrow, and kidney and the presence of cast nephropathy were identified on histologic examination.

CLINICAL RELEVANCE Multiple myeloma is rarely reported in horses. A monoclonal peak on serum protein electrophoresis should raise the suspicion of neoplasia, specifically multiple myeloma. The findings for this patient confirmed the importance of considering neoplasia in horses with nonspecific clinical signs.

Abstract

CASE DESCRIPTION A 27-year-old Dutch Warmblood mare was evaluated because of a history of lethargy, reluctance to move, weight loss, persistent hyperproteinemia, and recurrent episodes of mild lameness.

CLINICAL FINDINGS Hematologic evaluation revealed anemia (RBC concentration, 3.84 × 106 cells/μL), thrombocytopenia (47 × 103 thrombocytes/μL), and hyperproteinemia (total protein concentration, 11.2 g/dL) with hyperglobulinemia and hypoalbuminemia. Results of protein electrophoresis of serum and urine samples indicated a monoclonal gammopathy; the paraprotein was identified as a κ light chain. On abdominal ultrasonographic examination, hypoechoic nodules were visualized in the spleen. Results of cytologic examination of a splenic fine-needle aspirate and histologic examination of a bone marrow biopsy sample were consistent with plasma cell myeloma.

TREATMENT AND OUTCOME Treatment was declined owing to the age of the horse and poor prognosis. The horse was discharged from the hospital, and the owner was given palliative care instructions. The horse was euthanized 2 weeks later because of recurrent episodes of lethargy, anorexia, and signs of colic. Necropsy confirmed the diagnosis of multiple (plasma cell) myeloma. Plasma cell aggregates in the liver, spleen, bone marrow, and kidney and the presence of cast nephropathy were identified on histologic examination.

CLINICAL RELEVANCE Multiple myeloma is rarely reported in horses. A monoclonal peak on serum protein electrophoresis should raise the suspicion of neoplasia, specifically multiple myeloma. The findings for this patient confirmed the importance of considering neoplasia in horses with nonspecific clinical signs.

Contributor Notes

Address correspondence to Dr. Eberhardt (ceberhardt@vetclinics.uzh.ch).