J Korean Med Sci.  2023 Nov;38(44):e374. 10.3346/jkms.2023.38.e374.

Case 16: A 75-Year-Old Man With Macroglossia and Hypercalcemia

• Kim J
• Kim N
• Jeon Y
• Kim TY
• Kim TJ
• Kwon HS
• Park CS
• Baek KH

• KMID: 2547976
• DOI: http://doi.org/10.3346/jkms.2023.38.e374

Figure

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  Fig. 1 Clinical photograph of the patient. (A) Macroglossia. (B) Generalized edema predominantly seen in lower limb (The figures are published under agreement of the patient with a second informed consent).

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  Fig. 2 Initial findings of the patients. (A) Initial electrocardiogram presented non-specific conduction delay. (B) Chest X-ray showed cardiomegaly with pleural effusion (The figures are published under agreement of the patient with a second informed consent).

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  Fig. 3 Echocardiogram showed normal systolic function and no regional wall motion abnormality in parasternal long-axis view (A), and apical four-chamber view (B). Moderate left ventricular hypertrophy (left ventricular wall thickness = 1.6 cm) was obvious. Pulsed wave Doppler recording across the mitral valve showed diastolic dysfunction with restrictive pattern (C). Tissue Doppler image (D) and strain Doppler image (E) presented the relaxation abnormality with global strain reduction.

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  Fig. 4 Tissue biopsy. (A) Tongue biopsy showed subepithelial amorphous material depositions (H&E ×200). (B) Congo Red staining under a polarizing microscope showed apple green birefringence on the tongue, consistent with amyloid staining (×200). (C) Endocardial biopsy showed intramuscular amorphous material deposition (H&E ×200). (D) Congo Red staining under a polarizing microscope shewed apple green birefringence on the endocardium (×200).H&E = hematoxylin and eosin.

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  Fig. 5 Bone marrow biopsy. (A) CD138 plasma cell immunohistochemical staining showed 10% plasma cell cellularity (×200). (B) Bone marrow was positive for lambda immunohistochemical staining (×400).

Reference

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