Progressively invalidating orthostatic hypotension: A common symptom for a challenging diagnosis

Abstract

We discuss here an uncommon condition of neurogenic hypotension in the context of immunoglobulin light chain (amyloid
light-chain) amyloidosis. Th e most serious feature was autonomic nervous system impairment, mainly characterized by severe
refractory orthostatic hypotension, which became progressively invalidating, forcing the patient to bed. Moreover, since the systemic involvement of the disease, the patient presented also diarrhea, dysphagia, asthenia, peripheral edema because of gastrointestinal,and kidney dysfunction. Eventually, the massive myocardial depression and infi ltration led to a fatal outcome.

Key words: Amyloidosis, multiple myeloma, refractory hypotension, restrictive cardiomyopathy, tilt test