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Case Reports
. 2020 Jul 2;12(7):e8976.
doi: 10.7759/cureus.8976.

Amyloidosis Masquerading as Alcohol-Related Cirrhosis

Navroop Nagra  1 , Blaire Burman  2 , Christopher R Gault  3 , Russell Dorer  3 , Asma Siddique  2
Affiliations
Case Reports

Amyloidosis Masquerading as Alcohol-Related Cirrhosis

Navroop Nagra et al. Cureus. .

Abstract

Amyloidosis can affect multiple organs, and involvement of the heart is the most common cause of death. Signs and symptoms vary depending upon the organ system affected by amyloid. Liver involvement is often seen, but symptoms are usually mild and nonspecific in isolated hepatic amyloidosis. None of the laboratory markers and imaging is characteristic of this condition; therefore, diagnosis is often delayed. Tissue biopsy is required for definitive diagnosis. Herein, we report a case where the patient's symptoms had been attributed to alcohol-related cirrhosis; however, further workup ultimately led to a diagnosis of systemic amyloidosis with multi-organ involvement.

Keywords: alcohol; amyloidosis; ascites; ascitic fluid analysis; cardiac amyloidosis; cirrhosis; hepatic amyloidosis; multiple myeloma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Ultrasound of the abdomen
Ultrasound showing hepatomegaly, hepatic steatosis (yellow arrow), and ascites (white arrow).
Figure 2
Figure 2. MRI and magnetic resonance cholangiopancreatography of the abdomen
MRI showing ascites around liver and spleen (yellow arrows), and splenomegaly (white arrow).
Figure 3
Figure 3. Cardiac MRI
Concentric left ventricular myocardial thickening measuring over 20 mm, up to approximately 23 mm in the lateral wall (normal mid cavity thickness is 5-9 mm).
Figure 4
Figure 4. Bone marrow biopsy
Mildly hypercellular marrow with trilineage hematopoeisis.
Figure 5
Figure 5. Bone marrow biopsy
Stain for lambda light chain showing increased lambda-restricted plasma cells.
Figure 6
Figure 6. Liver biopsy
Congo red stain showing positive staining within the hepatic artery.
Figure 7
Figure 7. Liver biopsy
Congo Red stain under polarized light showing the typical “apple-green birefringence” of amyloid.
See this image and copyright information in PMC

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