Cardiac amyloidosis possibly secondary to Agent Orange exposure

Much research has focused on the association between the toxic metabolites of the tactical herbicide Agent Orange and several blood cancers, including systemic amyloid light-chain (AL) amyloidosis. Here we present a rare case of heart failure secondary to cardiac AL amyloidosis as a consequence of Agent Orange exposure. An elderly man was transferred to the intensive care unit for a suspected gastrointestinal bleed and decompensation of congestive heart failure. An echocardiogram suggested restrictive cardiomyopathy, and an abdominal fat pad biopsy confirmed amyloid involvement. The diagnosis of systemic AL amyloidosis was made following a free lambda to free kappa light chain ratio >3:1. Upon discussion with the patient, significant exposure to Agent Orange during deployment was affirmed. Subsequent care was taken over by the Veterans Affairs Medical Center.