A clinical case of systemic amyloidosis in a cardiologists’s practice

Klinicist

D. V. Dianov¹  V. A. Fomina¹  G. O. Ivanova¹  E. S. Soldatov¹  O. V. Evsina²  V. G. Okorokov²  A. V. Ganyuta²  K. A. Tkachenko² 

[1] Regional Clinical Cardiological Dispensary;Ryazan State Medical University named after academician I. P. Pavlov, Ministry of Health of Russia;

关键词: amyloidosis;    restrictive cardiomyopathy;    chronic kidney disease;    congestive heart failure;    differential diagnosis;    ultrasound diagnosis;    biopsy;    congo red;    proteinuria;    anemia;   

DOI  :  10.17650/1818-8338-2019-13-1-2-72-79

来源: DOAJ

【 摘 要 】

The aim of the work was to study the clinical case of systemic amyloidosis.Materials and methods. Patient Ch., 63 уears old, have admitted to the regional cardiological dispensary with complaints of short stabbing pains in the heart, without reaction to nitroglycerin, interruptions in the work of the heart, mainly at night, shortness of breath with little exertion, weakness, swelling of the legs and feet in September 2018. Sick from April 2016, when was dyspnea on exertion. The high level of creatinine, normochromic anemia have detected. In June 2016 chronic pyelonephritis was diagnosed. In August 2018, a right-sided hydrothorax was diagnosed, a pleural puncture was performed.Results. Laboratory and instrumental research methods were performed. Based on anamnesis data (normochromic anemia, proteinuria, increased creatinine in the blood), clinical picture, data of instrumental studies (restrictive cardiomyopathy, bilateral hydrothorax) clinical diagnosis was made: systemic amyloidosis the kidneys and heart with chronic kidney disease C5 and chronic heart failure. Histological evidence of amyloid and determination of the variant of amyloidosis by immunohistochemical method was recommended. But the patient died before the study. The histological verification of the diagnosis was carried out at the autopsy.Conclusion. This clinical observation is an example of late diagnosis of systemic amyloidosis and postmortal verification of the diagnosis, which is associated with the nonspecific symptoms and the rapidly progressing course of the disease. This case is interesting because amyloidosis proceeded under the guise of other diseases, quickly led to the development of severe heart and renal failure and to the death of the patient before verifying the disease.

【 授权许可】

Unknown