Publication date: Nov 01, 2024

BACKGROUND Focal segmental glomerulosclerosis (FSGS) very rarely occurs in patients with multiple myeloma. Much more common are renal impairments secondary to monoclonal light-chain tubulopathy, AL amyloidosis, light-chain deposition disease, and the so-called monoclonal gammopathy of renal significance. CASE REPORT We report the case of a 79-year-old myeloma patient without noticeable medical problems but with a long history of myeloma treatment beginning 13 years ago. In the ninth line of therapy, he was successfully treated with belamaf mafodotin, an anti-BCMA monoclonal antibody coupled to monomethyl auristatin F. After 1. 5 years of treatment, without any eye toxicity, and while he was in complete hematologic remission, he experienced a very severe COVID-19 infection followed 1 month later by a nephrotic syndrome. The renal biopsy revealed a FSGS not otherwise specified. He was successfully treated symptomatically. One and a half years later, and without treatment for 1 year, he is still in hematologic remission, with a remaining renal insufficiency. CONCLUSIONS Our patient had a particularly long response to belamaf mafodotin of more than 2. 5 years, which is still ongoing. This is particularly remarkable because the very unusual acute renal impairment was not myeloma related. This is a very rare case of FSGS in a myeloma patient, potentially linked to a COVID-19 infection considering the chronology of the events and the immunosuppressive status secondary to the malignancy and its treatment.

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