Old men and thickened hearts

The case of a patient with confirmed amyloid, initially believed to be light chain (AL) type, whose diagnosis was clouded by an atypical gastrointestinal tract system presentation and a concomitant haematological condition, is presented. Duodenal biopsy samples subsequently stained positive for transthyretin and the diagnosis was revised to senile systemic amyloidosis. The patient was managed medically and remains alive more than 2 years after the diagnosis was formally established. Differentiating the systemic amyloidoses from one another can be challenging as the features often overlap and the most sensitive tests usually require a tertiary referral. Ultimately, cases usually require histological verification from tissue biopsies. Helpful pointers can be obtained with a careful history and examination in combination with some routinely available diagnostic tests.