A systemic disease un…suspected by physical examination

A 73-year-old man was admitted to the cardiology department with unstable angina. He had a history of macroglossia with 3 years of development, attributed to hypothyroidism. On physical examination, he presented an exuberant macroglossia. The following diagnostic procedures were performed—ECG, in si...

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Bibliographic Details
Published in:BMJ case reports 2014-10, Vol.2014, p.bcr2014205919
Main Authors: Costa, Cátia, Severino, Davide, Pitta, Maria Luz, Leal, Margarida
Format: Article
Language:English
Subjects:
Aged
Amyloid - metabolism
Amyloidosis - diagnosis
Amyloidosis - etiology
Angina, Unstable - diagnosis
Angina, Unstable - etiology
Coronary Angiography
Coronary Vessels - pathology
Echocardiography
Europe (West)
Heart Ventricles - pathology
Humans
Immunoglobulin Light-chain Amyloidosis
Male
Multiple Myeloma - complications
Multiple Myeloma - diagnosis
Multiple Myeloma - pathology
Physical Examination
Rare Disease
Tongue
White
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Summary:A 73-year-old man was admitted to the cardiology department with unstable angina. He had a history of macroglossia with 3 years of development, attributed to hypothyroidism. On physical examination, he presented an exuberant macroglossia. The following diagnostic procedures were performed—ECG, in sinus rhythm with low voltage criteria, and transthoracic echocardiography, which revealed a left ventricle with preserved function and marked wall thickening, with low strain values in basal segments. The coronary angiography confirmed a lesion of 90% in the right coronary artery, treated with two stents. Suspecting a systemic infiltrative disease, additional tests were performed and these revealed the presence of systemic amyloid light-chain (AL) amyloidosis with cardiac involvement, associated with multiple myeloma. The patient was sent to a consult of haematology to begin chemotherapy.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-205919