A case of intramural coronary amyloidosis associated with hemodialysis

Authors

  • Faisal M. Huq Ronny New York Medical College. Westchester Medical Center. Department of Pathology
  • George Kleinman New York Medical College. Westchester Medical Center. Department of Pathology
  • Paul James Kurtin Mayo Clinic. Department of Laboratory Medicine and Pathology. Division of Hematopathology

DOI:

https://doi.org/10.4322/acr.2017.007

Keywords:

Renal Dialysis, Amyloidosis, Coronary Disease, Autopsy

Abstract

Dialysis-related amyloidosis predominantly occurs in osteo-articular structures and dialysis-related amyloid (DRA) substances also deposit in extra-articular tissues. Clinical manifestations of DRA include odynophagia, gastrointestinal hemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction, and subcutaneous tumors. The pathological characteristics of DRA in the heart of hemodialysis patients have rarely been reported. We report the case of a 73-year-old female with a history of cerebral palsy and end-stage renal disease status post two failed renal transplants who had been on hemodialysis for 30 years. The patient was admitted with the working diagnosis of pneumonia. An echocardiography showed markedly reduced biventricular function manifested by low blood pressure with systolic in the 70s and elevated pulmonary artery pressure of 45 mmHg, which did not respond to therapy. Following her demise, the autopsy revealed bilateral pulmonary edema and pleural effusions. There was cardiac amyloid deposition exclusively in the coronary arteries but not in the perimyocytic interstitium. Amyloids were also found in pulmonary and intrarenal arteries and the colon wall. Previous case reports showed that beta 2-microglobulin amyloid deposits in various visceral organs but less frequently in the atrial and/or the ventricular myocardium. In the present case, amyloids in the heart were present in the intramural coronary arteries causing myocardial ischemia and infarction, which was the immediate cause of death

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Published

2017-03-29

How to Cite

Ronny, F. M. H., Kleinman, G., & Kurtin, P. J. (2017). A case of intramural coronary amyloidosis associated with hemodialysis. Autopsy and Case Reports, 7(1), 13-15. https://doi.org/10.4322/acr.2017.007

Issue

Section

Article / Autopsy Case Report