Vertebral compression fractures as the initial presentation of AL amyloidosis: case series and review of literature

Abstract

The clinical presentation of AL amyloidosis is highly variable. In this series, we describe five cases of AL amyloidosis with vertebral compression fractures as initial presentation. All five patients had evidence of bone marrow replacement on magnetic resonance imaging and bone marrow biopsies demonstrating diffuse interstitial amyloid deposition. Hepatomegaly and elevated liver enzymes, consistent with liver involvement with amyloidosis, were also seen in each case. All five patients responded well to anti-plasma cell chemotherapy, with normalization of serum free light chain levels, reduction in alkaline phosphatase and improvement in pain and functional status. Although rare, AL amyloidosis should be considered in the differential diagnosis of selected patients with spontaneous vertebral compression fractures. Moreover, there seems to be an association of vertebral compression fractures with liver involvement in AL amyloidosis.

• AL amyloidosis
• bone
• vertebral compression fractures

Acknowledgements

We gratefully acknowledge our colleagues in the Amyloidosis Center, Cancer Clinical Trials Office, and Center for Cancer and Blood Disorders at Boston Medical Center who assisted with the multidisciplinary evaluation and treatment of the patients, and particularly the patients themselves who participated in this research study. We thank Dr Anita Deshpande for assistance with the images of the bone marrow biopsies.

Declaration of interest

The authors of this article have no pertinent conflicts of interest to disclose.