TTR and malnutrition: Notably, the patient’s long-term vegetarian diet and potential malnutrition(Hemoglobin: 59.00 g/L; Prealbumin: 15.3 mg/dL; Albumin: 34.7 g/L) may have contributed to immune compromise, which is consistent with the growing evidence linking immune dysregulation to the development of MPMNs (6).