Cholestatic jaundice in two patients with primary amyloidosis: ultrastructural findings of the liver

Primary Amyloidosis Presenting with Nephrotic Syndrome and Atypical Intrahepatic Cholestasis: Report of 2 Cases

Liver is one of the most commonly involved organs in both primary and secondary systemic amyloidoses, but hepatic amyloidosis, manifested as mild to moderate enlargement, is usually not symptomatic nor it is clinically problematic. Rarely, massive hepatomegaly, severe cholestatic hepatitis or liver failure may be encountered in patients with systemic amyloidosis. Two cases with lambda light-chain amyloidosis presenting with nephrotic syndrome and atypical intrahepatic cholestasis are discussed with clinical features, laboratory and kidney, liver and bone marrow biopsy findings in view of the relevant literature.

[Cholestatic jaundice and constitutional syndrome as early manifestations of primary systemic amyloidosis]

We present the case of a 70-year-old woman who had been suffering from constitutional syndrome for several months, abdominal distension, and yellowish coloration of the skin for the previous few days with a rapidly fatal course. Examination revealed hepatomegaly and ascites. Laboratory investigations revealed hyperbilirubinemia with cholestasis. The remaining investigations (abdominal ultrasound, barium transit evaluation, bone marrow study, analysis of ascitic fluid and laparoscopy) did not establish the diagnosis. This was established by liver and subcutaneous fatty tissue biopsies, which revealed type AL amyloid deposits. Autopsy confirmed that the patient had primary systemic amyloidosis. This infrequent form of presentation of systemic amyloidosis and its poor prognosis are discussed.