A male, 30 years of age, complained of systemic body swelling, shortness of breath, and decreased urine output with abnormal color for 2 months.
He had been diagnosed with abdominal Tb 10 years prior, for which he received systemic anti-Tb treatment. Clinical examination exhibited anasarca, particularly in the abdomen.
Abdominal ultrasound indicated massive ascites, and echocardiography indicated the ejection fraction reduced to 60%.
Renal biopsy revealed renal amyloidosis.
The patient was treated with ceftriaxone, furosemide, prednisolone, pantoprazole, spironolactone, calcium and mycophenolate mofetil, and his condition improved.
Amyloidosis (AL) is a group of rare diseases and pathologically is characterized by abnormal deposition of fibril-like insoluble amyloid protein in body organs, causing organ damage that leads to death.
There are approximately 60 heterogeneous amyloidogenic proteins, and 27 of these are associated with known human diseases, affecting the liver, kidney, peripheral nervous system, and heart.1
If the bone marrow is involved, the case may be linked with multiple myeloma.2
Without optimal treatment, AL has a very high death rate, of approximately 75% within a 2-year period after diagnosis.3
AL can be diagnosed pathologically and classified by immunohistochemistry and mass spectrometry.
A male patient, 30 years-old, was brought to Haj-Elsafi General Hospital, Khartoum, Sudan, on March 2019. He complained of systemic body swelling that had lasted for 2 months. He reported having begun to develop bilateral lower limb swelling, which was more severe while standing and walking and which also started 2 months prior (
. One month prior to hospital presentation, he noticed scrotal, abdominal and facial swelling (Fig. 1)
He had shortness of breath with exertion and when lying down. He reported that his urine output was reduced and frothy in the morning, but without obvious burning or pain sensations and without symptoms related to urinary tract obstruction.
He reported no fever, fatigue, no weight loss, appetite change, vomiting, abdominal pain, change in bowel habit, headache, memory functional change, nor effects of muscular movement.
Fig. 1 Patient display of systemic edema.
(a) Lower limb edema. (b) Ascites. (c) Sacral edema. (d) Facial swelling.
The patient reported smoking tobacco moderately and drinking alcohol occasionally. He was allergic to penicillin. He had no diabetes, hypertension nor chronic cardiovascular disease
is family members were generally healthy, with no specific reports of illness or conditions.
Physical examination found that, in general, he was weak but not pale or jaundiced.