Diagnostic Wandering in a Therapeutic Emergency: A Case Study of an AL Cardiac Amyloidosis Mimicking Tuberculosis

Abstract

Background: Cardiac amyloidosis corresponds to a buildup of fibrillar proteins in the myocardium. It is characterized by non-specific signs that often lead to a late diagnosis, even though it is an emergency in some cases. Objective: This case report emphasizes the very long route of care before the diagnosis of cardiac amyloidosis. Case Presentation: A 62-year-old woman with a history of close contact exposure to tuberculosis presented to a peripheral health center with a chronic cough. After several examinations, the diagnosis of pleural tuberculosis was retained. After two months of specific treatment, the patient did not improve, which motivated the request for echocardiography which found signs suggestive of cardiac amyloidosis. The questioning and the clinical examination were repeated. This gave arguments to continue the investigation which led to the final diagnosis of light chain (AL) cardiac amyloidosis. Discussion: The long route of care before diagnosis of cardiac amyloidosis worsens the prognosis because of the therapeutic delay. The patient often consults several specialists before arriving at the diagnosis. The presence of clinical signs called "red flags" associated with left ventricular hypertrophy should suggest cardiac amyloidosis. Cardiac MRI and biopsy of certain peripheral organs reduced the indication for endocardial biopsy for diagnostic purposes. Conclusion: To improve the prognosis, every clinician must know the red flags of cardiac amyloidosis.