title: Amyloidosis: an unusual cause of portal hypertension.
abstract: Amyloidosis comprises a group of diseases that occurs in five to nine cases per million patients per year worldwide irrespective of its classification. Although the hepatic involvement in primary amyloidosis is frequent, the clinical manifestations of liver amyloidosis are mild or even absent. The authors report the case of an aged man who complained of diffuse abdominal pain and marked weight loss and presented clinical signs of hepatopathy. Clinical workup revealed portal hypertension with ascites, hemorrhoids, and esophageal varices. The laboratory tests showed the cholestatic pattern of liver enzymes, hyperbilirubinemia, renal insufficiency and massive proteinuria accompanied by the presence of serum pike of monoclonal lambda light chain protein. The outcome was unfavorable, and the patient died. The autopsy findings revealed the diagnosis of amyloidosis predominantly involving the liver and kidneys. The bone marrow examination demonstrated the deposition of amyloid material associated with clonal plasma cells infiltration. The authors call attention to portal hypertension as a rare manifestation of primary amyloidosis. Meanwhile, this diagnosis should be taken into account whenever the hepatopathy is accompanied by laboratory abnormalities consistent with hepatic space-occupying lesions concomitantly with other organs involvement. In the case reported herein, kidney involvement was also present with renal failure, massive proteinuria with monoclonal serum gammopathy, what reinforced the diagnostic possibility of primary amyloidosis.
authors.affiliation: Internal Medicine Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
authors.forename: Vilma
authors.initials: V
authors.lastname: Takayasu
authors.affiliation: Internal Medicine Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
authors.forename: Lorena Silva
authors.initials: LS
authors.lastname: Laborda
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo/SP - Brazil .
authors.forename: Raquel
authors.initials: R
authors.lastname: Bernardelli
authors.affiliation: Internal Medicine Department - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil .
authors.forename: Henrique Trombini
authors.initials: HT
authors.lastname: Pinesi
authors.affiliation: Internal Medicine Department - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil .
authors.forename: Marilia Polo Minguete E
authors.initials: MP
authors.lastname: Silva
authors.affiliation: Anatomic Pathology - Grupo Fleury, São Paulo/SP - Brazil .
authors.forename: Viviane
authors.initials: V
authors.lastname: Chiavelli
authors.affiliation: Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil .
authors.forename: Angélica Braz
authors.initials: AB
authors.lastname: Simões
authors.affiliation: Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.; Department of Pathology - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil.
authors.forename: Aloisio
authors.initials: A
authors.lastname: Felipe-Silva
keywords: Amyloidosis; Hypertension, Portal; Liver Diseases; Multiple myeloma