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Dysphagia unveiling systemic immunoglobulin light-chain amyloidosis with multiple myeloma
  1. Juan Gonzalez,
  2. Ahsan Wahab,
  3. Kavitha Kesari
  1. Internal Medicine, McLaren Health Care Corp, Flint, Michigan, USA
  1. Correspondence to Dr Ahsan Wahab, DrAhsan.Wahab{at}


Dysphagia is an uncommon presentation of systemic immunoglobulin light-chain (AL) amyloidosis with multiple myeloma (MM). Gastrointestinal (GI) involvement usually manifests with altered motility, malabsorption or bleeding. Furthermore, patients identified with GI amyloidosis, without previous diagnosis of a plasma cell disorder, are extremely rare. We report an elderly woman who presented with acute on chronic cardiac dysfunction, sick sinus syndrome and acute renal failure. While admitted, she developed intermittent dysphagia to both solids and liquids. Oesophagogastroduodenoscopy showed ulcerations of oesophagus and duodenum. Biopsies revealed focal amyloid deposition, stained with Congo red. Renal biopsy revealed amyloid deposition in renal arterioles. She underwent a bone marrow biopsy confirming MM, represented by more than 15% plasma cell population. She was started on treatment for heart failure, induction chemotherapy for MM and percutaneous gastrostomy tube for feeding. However, she continued to deteriorate, eventually opting for hospice, and ultimately died 2 days after discharge from hospital.

  • heart failure
  • gastrointestinal system
  • endoscopy

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  • Contributors JG did the literature search and wrote the discussion portion of the case report. AW wrote the case section of the case report and edited the discussion portion. KK helped in editing the case. She also wrote the summary section of the case report.

  • 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.

  • Patient consent Not required.

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