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Takayasu V, Laborda LS, Bernardelli R, et al. Amyloidosis: an unusual cause of portal hypertension. Autops Case Rep. 2016;6(2):9-18doi: 10.4322/acr.2016.035.
Takayasu, V., Laborda, L. S., Bernardelli, R., Pinesi, H. T., Silva, M. P., Chiavelli, V., Simões, A. B., & Felipe-Silva, A. (2016). Amyloidosis: an unusual cause of portal hypertension. Autopsy & case reports, 6(2), 9-18. https://doi.org/10.4322/acr.2016.035
Takayasu, Vilma, et al. "Amyloidosis: an unusual cause of portal hypertension." Autopsy & case reports vol. 6,2 (2016): 9-18. doi: https://doi.org/10.4322/acr.2016.035
Takayasu V, Laborda LS, Bernardelli R, Pinesi HT, Silva MP, Chiavelli V, Simões AB, Felipe-Silva A. Amyloidosis: an unusual cause of portal hypertension. Autops Case Rep. 2016 Jun 30;6(2):9-18. doi: 10.4322/acr.2016.035. eCollection 2016. PMID: 27547738; PMCID: PMC4982779.
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Autops Case Rep. 2016 Jun 30;6(2):9-18. doi: 10.4322/acr.2016.035. eCollection 2016.

Amyloidosis: an unusual cause of portal hypertension.

Autopsy & case reports

Vilma Takayasu, Lorena Silva Laborda, Raquel Bernardelli, Henrique Trombini Pinesi, Marilia Polo Minguete E Silva, Viviane Chiavelli, Angélica Braz Simões, Aloisio Felipe-Silva

Affiliations

  1. Internal Medicine Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
  2. Instituto de Infectologia Emilio Ribas, São Paulo/SP - Brazil .
  3. Internal Medicine Department - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil .
  4. Anatomic Pathology - Grupo Fleury, São Paulo/SP - Brazil .
  5. Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
  6. Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.; Department of Pathology - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil.

PMID: 27547738 PMCID: PMC4982779 DOI: 10.4322/acr.2016.035

Abstract

Amyloidosis comprises a group of diseases that occurs in five to nine cases per million patients per year worldwide irrespective of its classification. Although the hepatic involvement in primary amyloidosis is frequent, the clinical manifestations of liver amyloidosis are mild or even absent. The authors report the case of an aged man who complained of diffuse abdominal pain and marked weight loss and presented clinical signs of hepatopathy. Clinical workup revealed portal hypertension with ascites, hemorrhoids, and esophageal varices. The laboratory tests showed the cholestatic pattern of liver enzymes, hyperbilirubinemia, renal insufficiency and massive proteinuria accompanied by the presence of serum pike of monoclonal lambda light chain protein. The outcome was unfavorable, and the patient died. The autopsy findings revealed the diagnosis of amyloidosis predominantly involving the liver and kidneys. The bone marrow examination demonstrated the deposition of amyloid material associated with clonal plasma cells infiltration. The authors call attention to portal hypertension as a rare manifestation of primary amyloidosis. Meanwhile, this diagnosis should be taken into account whenever the hepatopathy is accompanied by laboratory abnormalities consistent with hepatic space-occupying lesions concomitantly with other organs involvement. In the case reported herein, kidney involvement was also present with renal failure, massive proteinuria with monoclonal serum gammopathy, what reinforced the diagnostic possibility of primary amyloidosis.

Keywords: Amyloidosis; Hypertension, Portal; Liver Diseases; Multiple myeloma

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