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Published 5 March 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.09.2008.0921]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Reminder of important clinical lesson

A dilemma solved

Muhammad Khizar Rafiq

Royal Hallamshire Hospital, Neurology Department, Glossop Road, Sheffield, S10 2JF, UK

Correspondence to:
drmkrafiq{at}hotmail.com

SUMMARY

A 63-year-old woman with severe symptomatic postural hypotension was treated unsuccessfully, and no underlying cause was found for 3 years until she was noted to have hypoalbuminaemia and proteinuria. A renal biopsy led to the diagnosis of amyloidosis. Despite being an established cause for autonomic neuropathy, amyloidosis was not suspected early enough. Although a diagnosis was reached and treatment started, the patient died as a complication of chemotherapy.


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