title: 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. The 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 infiltration led to a fatal outcome.
authors.affiliation: Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Pelusi
authors.affiliation: Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Lombardi
authors.affiliation: Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Airaghi
authors.affiliation: Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Larry
authors.initials: L
authors.lastname: Burdick
authors.affiliation: Department of Neurological Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rango
authors.affiliation: Department of Physiatry and Rheumatology, Division of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Penatti
authors.affiliation: Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fargion
keywords: Amyloidosis; multiple myeloma; refractory hypotension; restrictive cardiomyopathy; tilt test