Case Study: Cardiac Amyloidosis with Overt MM Presenting with Pulmonary Symptoms

A case study published in the Journal of Surgical Case Reports detailed an unusual instance of cardiac amyloidosis with over multiple myeloma (MM) presenting with pulmonary symptoms.

In this case, 65-year-old woman, nonsmoker, non-alcoholic, known to have hypothyroidism and multiple myeloma, presented shortness of breath and basilar crackles. A chest scan revealed showed a build-up of fluid in both lungs, as well as bilateral bone osteodegenerative, diffuse subcutaneous thickening, and a parenchymal nodule of 3 mm seen in the subpleural region of the posterior region right upper lobe. Another pleural base nodule of 5 mm was seen at the level of left lateral basal segment.

The patient was administered medication regimen of Lasix (20 mg IVD Q12HRS), Duphalac (20 cc P.O. daily), Perfalgon (Q8 1g) along with cardiac and pulmonary consultations. Her symptoms then improved, and she was discharged from the hospital. However, three months later, the patient presented with shortness of breath and chest pain. Her chest X-ray displayed bilateral pleural effusions with underlying lower lobe consolidation/atelectasis. She was given an echo cardiac Doppler which showed severely restrictive cardiomyopathy with very high filing pressure secondary to AL amyloidosis, as well severe left ventricular hypertrophy with bilateral enlargement. Subsequent tests lead to the diagnosis of cardiac amyloidosis and MM.

“Owing to the lack of diagnostic criteria, cardiac amyloidosis is a major challenge for physician. Noncardial clinical symptoms include generalized fatigue, purpura, sensorimotor polyneuropathy, carpal tunnel syndrome and lumbar spinal stenosis. A growing body of evidence has highlighted a link between amyloidosis and MM, and an estimated rate of 10–15% of amyloidosis patients might develop MM,” the researchers concluded.

“The current therapeutic criteria for amyloidosis are based on the precursor-product concept. Inhibiting the precursor of amyloid deposition will decrease the progression of the disease and stabilize it. A wide variety of treatments is available based on amyloidosis type. Concerning the MM, hematopoietic stem cell transplantation plays a pivotal role in the management. Potential candidates to autologous stem-cell transplantation are treated initially with two to four cycles of nonmelphalan containing induction therapy.”