Background: A 69-year-old man with multiple myeloma and left-sided heart failure presented to the hospital with a two-month fever. Method: A transjugular liver biopsy was performed due to the rapid progression of liver failure. The procedure was complicated by an intraperitoneal hemorrhage. The bleeding was managed expectantly. Result: Significantly elevated serum bilirubin levels occurred on the 13th day after liver biopsy. Increasing serum bilirubin levels were observed until the patient's death due to a biliovenous fistula at the liver biopsy site. Simultaneously, his slightly elevated liver enzymes returned to normal. The patient died 23 days after liver biopsy due to acute respiratory distress syndrome. Fistulous communication between the biliary tree and the hepatic venous system with subsequent bile leakage into the venous system (bilhemia) can lead to bile deposition in the lungs. Bile deposition in the lungs may potentiate and accelerate the development of diffuse alveolar damage with hyaline membranes. Conclusions: Lambda and kappa light chain deposition in the pulmonary alveoli in patients with multiple myeloma can mimic typical hyaline membranes.

1st Department of Surgery Louis Pasteur University Hospital Rastislavova 43 040 01 Košice Slovakia

2nd Department of Internal Medicine Pavol Jozef Šafárik University Louis Pasteur University Hospital Trieda SNP 1 040 11 Košice Slovakia

Department of Forensic Medicine Faculty of Medicine Pavol Jozef Šafárik University Trieda SNP 1 041 11 Košice Slovakia

Department of Pathology and Molecular Medicine 3rd Faculty of Medicine Charles University Thomayer University Hospital Vídeňská 800 140 59 Prague Czech Republic

Department of Pathology Louis Pasteur University Hospital Rastislavova 43 040 01 Košice Slovakia

Department of Radiodiagnostics and Imaging Techniques Pavol Jozef Šafárik University Trieda SNP 1 040 11 Košice Slovakia

Medicolegal Department of Health Care Surveillance Authority Ipeľská 1 043 74 Košice Slovakia

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