Negative for AL and ATTR: Could It Still Be Amyloid?

Amyloidosis is a systemic disease characterized by the extracellular deposition of misfolded proteins. We present a rare case of familial amyloidosis with multiorgan involvement. A 68-year-old woman initially presented with shortness of breath and syncope. Past medical history included chronic kidne...

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Main Authors: Ahmed B. Elawad, Paul Wilkinson, Ryan Kimball, Ahmed F. Abdulrahim
Format: Article
Language:English
Published: American College of Physicians 2025-06-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2024.1208
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author Ahmed B. Elawad
Paul Wilkinson
Ryan Kimball
Ahmed F. Abdulrahim
author_facet Ahmed B. Elawad
Paul Wilkinson
Ryan Kimball
Ahmed F. Abdulrahim
author_sort Ahmed B. Elawad
collection DOAJ
description Amyloidosis is a systemic disease characterized by the extracellular deposition of misfolded proteins. We present a rare case of familial amyloidosis with multiorgan involvement. A 68-year-old woman initially presented with shortness of breath and syncope. Past medical history included chronic kidney disease, skin bronzing, and macroglossia. An echocardiogram revealed asymmetric septal hypertrophy, which prompted serum marker testing for common forms of amyloidosis. These tests returned negative for light-chain and transthyretin amyloidosis. Later genetic testing confirmed an APOA1 gene mutation. This case highlights the importance of considering hereditary forms of amyloidosis, particularly when tests for light-chain and transthyretin amyloidosis are negative.
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publisher American College of Physicians
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series Annals of Internal Medicine: Clinical Cases
spelling doaj-art-e63aae666f484e9b9915da1a8d038e832025-08-20T03:19:20ZengAmerican College of PhysiciansAnnals of Internal Medicine: Clinical Cases2767-76642025-06-014610.7326/aimcc.2024.1208Negative for AL and ATTR: Could It Still Be Amyloid?Ahmed B. Elawad0Paul Wilkinson1Ryan Kimball2Ahmed F. Abdulrahim31Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska2Creighton University School of Medicine, Omaha, Nebraska2Creighton University School of Medicine, Omaha, Nebraska3Department of Pathology, Creighton University School of Medicine, Omaha, NebraskaAmyloidosis is a systemic disease characterized by the extracellular deposition of misfolded proteins. We present a rare case of familial amyloidosis with multiorgan involvement. A 68-year-old woman initially presented with shortness of breath and syncope. Past medical history included chronic kidney disease, skin bronzing, and macroglossia. An echocardiogram revealed asymmetric septal hypertrophy, which prompted serum marker testing for common forms of amyloidosis. These tests returned negative for light-chain and transthyretin amyloidosis. Later genetic testing confirmed an APOA1 gene mutation. This case highlights the importance of considering hereditary forms of amyloidosis, particularly when tests for light-chain and transthyretin amyloidosis are negative.https://www.acpjournals.org/doi/10.7326/aimcc.2024.1208
spellingShingle Ahmed B. Elawad
Paul Wilkinson
Ryan Kimball
Ahmed F. Abdulrahim
Negative for AL and ATTR: Could It Still Be Amyloid?
Annals of Internal Medicine: Clinical Cases
title Negative for AL and ATTR: Could It Still Be Amyloid?
title_full Negative for AL and ATTR: Could It Still Be Amyloid?
title_fullStr Negative for AL and ATTR: Could It Still Be Amyloid?
title_full_unstemmed Negative for AL and ATTR: Could It Still Be Amyloid?
title_short Negative for AL and ATTR: Could It Still Be Amyloid?
title_sort negative for al and attr could it still be amyloid
url https://www.acpjournals.org/doi/10.7326/aimcc.2024.1208
work_keys_str_mv AT ahmedbelawad negativeforalandattrcoulditstillbeamyloid
AT paulwilkinson negativeforalandattrcoulditstillbeamyloid
AT ryankimball negativeforalandattrcoulditstillbeamyloid
AT ahmedfabdulrahim negativeforalandattrcoulditstillbeamyloid