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Case Reports in Oncological Medicine
Volume 2015 (2015), Article ID 917157, 4 pages
Case Report

Diaphragmatic Amyloidosis Causing Respiratory Failure: A Case Report and Review of Literature

1Department of Internal Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065-4897, USA
2Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065-4897, USA

Received 20 June 2015; Revised 22 September 2015; Accepted 29 September 2015

Academic Editor: Josep M. Ribera

Copyright © 2015 Aleksey Novikov et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Neuromuscular respiratory failure is a rare complication of systemic immunoglobulin light chain amyloidosis. We describe a case of a 70-year-old Caucasian man with multiple myeloma who presented with worsening dyspnea. The patient was diagnosed with and treated for congestive heart failure but continued to suffer from hypercapnic respiratory insufficiency. He had restrictive physiology on pulmonary function tests and abnormal phrenic nerve conduction studies, consistent with neuromuscular respiratory failure. The diagnosis of systemic immunoglobulin light chain amyloidosis was made based on the clinical context and a cardiac biopsy. Despite treatment attempts, the patient passed away in the intensive care unit from hypercapnic respiratory failure. Autopsy revealed dense diaphragmatic amyloid deposits without phrenic nerve infiltration or demyelination or lung parenchymal involvement. Only 5 cases of neuromuscular respiratory failure due to amyloid infiltration of the diaphragm have been described. All cases, including this, were characterized by rapid progression and high mortality. Therefore, diaphragmatic amyloidosis should be on the differential for progressive neuromuscular respiratory failure in patients with multiple myeloma or any other monoclonal gammopathy. Given its poor prognosis, early recognition of this condition is essential in order to address goals of care and encourage pursuit of palliative measures.