Multiple arterial and venous thromboembolic complications in AL amyloidosis and cardiac involvement: a case report and literature review

Abstract

A 41-year-old woman with immunoglobulin light chain (AL) systemic amyloidosis with cardiac and gastrointestinal involvement developed multiple arterial and venous thromboembolic complications. Treatment with unfractionated heparin was complicated by life-threatening gastrointestinal bleeding. Work up for hereditary thrombophilia was unrevealing. Treatment with cyclophosphamide, bortezomib and dexamethasone combination regimen led to hematologic response without further thromboembolic complications. While thromboembolic complications have been reported in AL amyloidosis and cardiac involvement, this unique case highlights the complexity of the disease, the various pathogenic mechanisms at play and the difficult management decisions necessary in caring for these complex patients. A literature review of thrombembolic complications in patients with amyloidosis is presented.

Keywords::

• AL amyloidosis
• thrombosis
• cardiac involvement
• embolism

Acknowledgements

We gratefully acknowledge our colleagues in the Amyloid Treatment and Research Program, Clinical Trials Office, and Solomont Center for Cancer and Blood Disorders at Boston University School of Medicine and Boston Medical Center who assisted with the multidisciplinary evaluation and treatment of the patients with AL amyloidosis.

Declaration of interest: This work was supported in part by the Amyloid Research Fund at Boston University School of Medicine.