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Lingual liability: macroglossia and dyspnoea as the harbinger of systemic AL (light-chain) cardiac amyloidosis
  1. Michael Uncle Williams1,
  2. Caroline E Murphy2,
  3. Rosco Steven Gore3 and
  4. Emilio Fentanes4
  1. 1 Department of Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
  2. 2 Department of Medicine, Tripler Army Medical Center, Tripler, Hawaii, USA
  3. 3 Division of Cardiology, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
  4. 4 Division of Cardiology, Tripler Army Medical Center, Tripler, Hawaii, USA
  1. Correspondence to Dr Michael Uncle Williams, mikeuwilliams{at}


A 58-year-old man presented with a chief complaint of tongue indentations and discomfort. Otolaryngology treated him for oral thrush with counselling to avoid tongue biting. In addition, the patient reported dyspnoea described as a decrease in tolerance of his physical activities. Due to continued increase in tongue size and worsening dyspnoea, he underwent a tissue biopsy with findings consistent with amyloidosis. Further evaluation with a bone marrow biopsy revealed underlying multiple myeloma. Echocardiography revealed abnormal ventricular wall thickness, with a reduced left ventricular chamber size, dilated atria and Doppler findings with restrictive filling patterns indicative of cardiac amyloidosis. The patient was initiated on chemotherapy for his multiple myeloma and supportive therapy for his cardiac amyloidosis. Light-chain amyloidosis (AL) is a systemic disease characterised by irreversible deposition of amyloid in tissues throughout the body; when there is cardiac involvement, it can result in heart failure with a poor prognosis. Early diagnosis of cardiac amyloidosis can lead to prolonged survival.

  • cardiovascular medicine
  • medical education
  • oncology
  • ophthalmology
  • otolaryngology / ENT

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  • Patient consent for publication Obtained.

  • Contributors MUW involved in conception, logistics/planning (obtained informed consent, image acquisition with medical images), drafted initial manuscript, revision. CEM participated in writing the manuscript, revision. RSG drafted manuscript revision, approval of final version. EF involved in planning, manuscript revision, recommended BMJ Case Report, planning and approval of final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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