BMJ Case Reports 2009; doi:10.1136/bcr.09.2008.0921
  • Reminder of important clinical lesson

A dilemma solved

  1. Muhammad Khizar Rafiq
  1. Royal Hallamshire Hospital, Neurology Department, Glossop Road, Sheffield, S10 2JF, UK
  1. drmkrafiq{at}
  • Published 5 March 2009


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.


  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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