Refractory hypotension in amyloidosis patient: A case report

Refractory hypotension in AL amyloidosis

Abstract

Background: shock is a critical condition resulting from circulatory failure and is commonly observed in intensive care settings. It arises from four primary mechanisms, including hypovolemic, cardiogenic, distributive, and obstructive shock. However, some cases lack an identifiable cause or present with conditions mimicking sepsis. Rare causes, such as autonomic dysfunction, manifest through cardiovascular abnormalities like orthostatic hypotension and abnormal vasovagal responses. We reported here a case of autonomic dysfunction with amyloidosis due to its uncommon nature and significant influence on mortality rates. Timely and precise diagnosis, coupled with effective treatment, has the potential to be life-saving for the patient.

Case presentation: A 73-year-old female with a past medical history of curative breast cancer 15 years ago, sick sinus syndrome status post DDDR 3 years ago, and previous heart failure with an unremarkable coronary angiography result, presented for evaluation of progressive dysphagia. Following admission for esophagogastroduodenoscopy, she developed clinical symptoms consistent with septic shock and acute kidney injury with volume overload, which resolved after appropriate treatment. Subsequently, the patient experienced unexplained hypotension accompanied by periorbital ecchymosis, prompting a skin biopsy, serum protein electrophoresis, and free light chain testing, ultimately leading to a diagnosis of AL amyloidosis. After discussing the treatment plan, the patient opted for palliative care, and pharmacotherapy was provided as part of supportive management.

Conclusion: Refractory hypotension in AL amyloidosis poses a multifaceted clinical challenge, requiring a thorough and individualized treatment approach that considers the unique circumstances and therapeutic requirements of each patient.