P144 | A challenging dyslipidemia

D. Triggiani, E. Berardi, G. Antonica | Department of Interdisciplinary Medicine, Clinica Medica “C. Frugoni”, Aldo Moro University of Bari, Italy

Premises: The high prevalence of primary dyslipidemias often leads to overlook the differential diagnosis of other diseases, in which dyslipidemia is an epiphenomenon.
Description of the Case report: A man presented at our outpatient clinic with mixed dyslipidemia, developed approximately 2 years earlier, unresponsive to therapy with Atorvastatin 80 mg and Fenofibrate 145 mg. The patient, who was in normal range of weight, was affected by type 2 diabetes mellitus and carotid atherosclerosis. He reported an unexplained weight loss of around 10 kg in the past year, complained of fatigue, and sporadic limb paresthesias. Hematochemical tests revealed nephrotic syndrome with severe proteinuria (12 g/24h), hypoalbuminemia and mixed dyslipidemia (LDL cholesterol 250 mg/dL; tryglycerides 413 mg/dL); a monoclonal component (IgA-k) was found out in serum protein electrophoresis, with Bence Jones protein, elevated proBNP, and alkaline phosphatase; hemoglobin and calcium levels were in normal range. Echocardiogram showed left ventricular hypertrophy without systolic impairment, while abdomen ultrasonography did not reveal any abnormalities. The patient underwent a renal biopsy, with the final diagnosis of AL amyloidosis; hence chemotherapy was soon started.
Conclusions: Amyloidosis is a vastly underdiagnosed systemic condition. In patients with dyslipidemia, the presence of monoclonal gammopathy along with proteinuria should prompt consideration of AL amyloidosis in the differential diagnosis.