Unusual clinical course, Challenging differential diagnosis
Fernanda Stofer, Maria Fernanda Barretto, Ana Luisa Gouvea, Mario Ribeiro, Marcio Neves, Ronaldo Altenburg Gismondi, Luís Otavio Mocarzel
Department of Clinical Medicine, Fluminense Federal University, Niterói, Brazil
Am J Case Rep 2016; 17:439-443
Available online: 2016-06-29
The clinical manifestations of amyloidosis depend on the type of insoluble protein as well as the location of amyloid deposits in tissues or organs. In the gastrointestinal tract, the small intestine is the most common site of amyloid deposits, whereas peritoneal involvement and ascites are rare.
CASE REPORT: We report on a case of ascites due to peritoneal amyloidosis. A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators. Despite improvement in pulmonary congestion and peripheral edema, his ascites was not reduced. Echocardiogram revealed restrictive cardiomyopathy and a speckle-tracking pattern suggestive of cardiac amyloidosis. Subcutaneous and peritoneal biopsies revealed amyloidosis.
CONCLUSIONS: Amyloidosis is rare in the peritoneum and is usually asymptomatic. Ascites occurs in only 20% of patients with peritoneal amyloidosis. We searched PubMed using “ascites” and “amyloidosis” and identified only eight case reports of amyloidosis with ascites. Physicians should be particularly careful in heart failure and anasarca cases when ascites is disproportional or not responsive to diuretic treatment. To date, there is no specific treatment for peritoneal amyloidosis.
Keywords: Amyloidosis - complications, Aged, Ascites - etiology, Humans, Male, Peritoneal Diseases - complications, Rare Diseases - etiology