Dysphagia due to multiple myeloma with amyloidosis revealed by videofluoroscopic swallowing study

초록

Objective To report a rare case of MM associated with tongue amyloidosis. He represents with dysphagia and it was diagnosed with videofluoroscopic swallowing study (VFSS). It is the first report of dysphagia due to MM a with amyloidosis revealed by VFSS. Case A 61-year-old male presented with a progressive dysphagis with macroglossia and rigid tongue of 2 years duration. He had visited an otolaryngologist for tongue pain 4 years previously when he was diagnosed with oral ulcer and given conservative management with observation. However, his symptoms had not subsided, rather he had developed progressive dysphasia since then. He revisited our hospital for dysphagia, which was accompanied with dysarthria. At our dysphagia clinic, physical examination showed that the patient had macroglossia and rigid tongue (his tongue rarely moved), which resulted in a highly restricted range of motion. He had been on a puree diet and showed coughing sign of aspiration during liquid swallowing. Other systemic examinations were normal. On investigation, videofluoroscopic swallowing study (VFSS) revealed oral phase dysfunction. Tongue motions for searching and mixing food were diminished for liquid and solid foods. He showed drooling with liquid (Fig. 1.). Swallowing reflex was normal, but during the pharyngeal phase, decreased elevation and closure of larynx were observed. Food remnants were observed in the vallecular recess and pyriform sinus after swallowing. Liquid aspiration and semiliquid and semisolid penetration were evident (Fig. 1) Laboratory examination showed the presence of anemia and hypercalcemia. A hemato-oncologist was consulted for the evaluation of anemia and hypercalcemia. Further analysis showed; serum lambda light chain 920 mg/L (NL: 5.71-26.30 mg/L), serum kappa light chain 26.12 mg/L (NL: 3.30-19.40 mg/L), beta 2-microglobulin 5.36 mg/dL (NL: 1.00-2.40 mg/dL), and an r-globulin monoclonal peak (by urine protein electrophoresis). Neck MRI showed hypertrophy of