# A patient with AL amyloidosis presenting with refractory tuberculosis, chest tightness and hypotension: case report

## TL;DR

A patient with AL amyloidosis was misdiagnosed with tuberculosis, highlighting the importance of considering rare diseases in complex cases.

## Contribution

The case emphasizes the diagnostic challenge of AL amyloidosis and the need for comprehensive evaluation in patients with multi-organ symptoms.

## Key findings

- The patient's symptoms and tests confirmed AL amyloidosis, not refractory tuberculosis.
- Cardiac biomarkers and amyloid deposition in tissue biopsy were key diagnostic indicators.
- Bronchoalveolar lavage and bone marrow findings revealed underlying pathologies.

## Abstract

Immunoglobulin light chain (AL) amyloidosis presents a clinical spectrum characterized by diverse manifestations and involvement of multiple organs, posing a significant diagnostic challenge for physicians.

We present a case of a patient admitted to our hospital due to recurrent cough and sputum, which was initially diagnosed as refractory tuberculosis. Throughout his hospitalization, the patient experienced distressing symptoms, including uncontrollable chest tightness, hypotension, and fever. Noteworthy observations included a persistent elevation in cardiac biomarkers, indicative of cardiac damage. Bronchoalveolar lavage revealed the presence of various pathogenic microorganisms, while bone marrow flow cytometry demonstrated the existence of clonal plasma cells. Additionally, the urine free light chain assay detected the presence of M protein, and the positive congo red staining of the abdominal wall fat biopsy confirmed amyloid deposition in the tissues. Taking into account the patient’s clinical presentation and the examination findings, we reached a conclusive diagnosis of immunoglobulin light chain (AL) amyloidosis.

This case serves as a reminder for physicians to consider rare diseases like AL amyloidosis when patients present with symptoms involving multiple organ systems such as heart, lung and kidney that are unresponsive to conventional treatment options.