Amyloidosis: an unusual cause of portal hypertension

Authors

  • Vilma Takayasu Universidade de São Paulo. Hospital Universitário. Internal Medicine Division
  • Lorena Silva Laborda Universidade de São Paulo. Hospital Universitário. Internal Medicine Division
  • Raquel Bernardelli Instituto de Infectologia Emilio Ribas
  • Henrique Trombini Pinesi Universidade de São Paulo. Faculty of Medicine. Internal Medicine Department
  • Marilia Polo Minguete e Silva Universidade de São Paulo. Faculty of Medicine. Internal Medicine Department
  • Viviane Chiavelli Grupo Fleury. Anatomic Pathology
  • Angélica Braz Simões Universidade de São Paulo. Hospital Universitário. Anatomic Pathology Service
  • Aloisio Felipe-Silva Universidade de São Paulo. Hospital Universitário. Anatomic Pathology Service Universidade de São Paulo. Faculty of Medicine. Department of Pathology

DOI:

https://doi.org/10.4322/acr.2016.035

Keywords:

Amyloidosis, Liver Diseases, Hypertension, Portal, Multiple myeloma

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

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Published

2016-06-11

How to Cite

Takayasu, V., Laborda, L. S., Bernardelli, R., Pinesi, H. T., Silva, M. P. M. e, Chiavelli, V., Simões, A. B., & Felipe-Silva, A. (2016). Amyloidosis: an unusual cause of portal hypertension. Autopsy and Case Reports, 6(2), 9-18. https://doi.org/10.4322/acr.2016.035

Issue

Section

Article / Autopsy Case Report