Follow-up
Bictegravir/emtricitabine/tenofovir alafenamide treatment was
immediately started. Dermatologist consultation evaluating skin
desquamative-erythematous and itchy lesions diagnosed mild to moderate
vulgaris psoriasis and recommended topical therapy with calcipotriol and
betamethasone. The patient was then discharged in mild clinical
condition with outpatient cardiological and internal medicine follow-up
within 10 days after discharge. Cardiac therapy at discharge was based
on furosemide 50 mg and bisoprolol 2.5 mg daily. Moreover, a bone marrow
biopsy was scheduled. At the follow-up visit, patient lower limbs edema
had worsened and high-grade proteinuria was stable. Spironolactone 50
mg/day and losartan 12.5 mg/day were then prescribed. Due to persistent
mild hypotension (95/60 mmHg), losartan and spironolactone were soon
suspended, furosemide dosage was increased up to 150 mg/day and
dapaglifozin 10 mg was then started with subsequent significant decrease
in lower limbs edema. One month after discharge, Doppler ultrasound of
lower limbs showed resolution of DVT. Bone marrow biopsy revealed 30%
CD138+, CD20-, CD56-/+, D1 Cyclin- monoclonal plasma cells with no sign
of amyloid infiltration expressing lambda light chain. After obtaining
viral load suppression, the patient is going to start bortezomib-based
induction therapy plus daratumumab.