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Orthostatic hypotension and polyneuropathy: case report A 64-year-old man developed orthostatic hypotension and polyneuropathy during treatment with bortezomib, dexamethasone and lenalidomide for multiple myeloma [durations of treatments to reactions onsets not stated]. The man, who had multiple myeloma, was hospitalised due to recurrent syncope. He has recently been diagnosed with immunoglobulin Gk AL multiple myeloma, for which he had been receiving a chemotherapy regimen comprising bortezomib, dexamethasone and lenalidomide [routes and dosages not stated]. However, he subsequently developed mild neurologic symptoms, involving numbness and tingling, which eventually progressed to profound, recurrent episodes of syncope with minimal activity or standing. He also developed orthostatic hypotension, which was thought to be secondary to chemotherapy or autonomic dysfunction. The man received fludrocortisone, midodrine and unspecified supportive measures for the orthostatic hypotension, but with only minimal improvement. He also developed polyneuropathy, which was confirmed by electromyography and subsequently treated with immune globulin for a possible autoimmune autonomic neuropathy; polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma-proliferative disorder and skin changes (POEMS) syndrome was also considered. Meanwhile, chemotherapy was withheld. Work-up for a primary central neurologic aetiology was found negative. Given his clinical presentation, AL amyloidosis was suspected. His postural hypotension eventually progressed to the extent that he experienced multiple falls, becoming essentially bedbound. Subsequent analyses revealed an epicardial amyloid mass, which was eventually was diagnosed as an amyloidoma. Due to the finding of amyloid, his polyneuropathy was attributed to chemotherapy, as well as systemic AL amyloidosis. He subsequently resumed chemotherapy with daratumumab and dexamethasone. He also received droxidopa, fludrocortisone, midodrine and pyridostigmine for orthostatic hypotension, resulting in significant improvement [not all outcomes stated]. Iyer AM, et al. Atypical Case of Epicardial Amyloid Mass without Classical Features of Myocardial Infiltration. CASE 4: 160-165, No. 3, Jun 2020. Available from: URL: 803499843 http://doi.org/10.1016/j.case.2019.12.003

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Reactions 5 Sep 2020 No. 1820