Case Report: Sepsis With Multisystemic Amyloid Light-Chain Amyloidosis

Systemic light-chain (AL) amyloidosis is a complex disorder characterized by extracellular fibril deposition, leading to severe multisystem dysfunction. When sepsis superimposes on preexisting organ impairment, early clinical recognition becomes particularly challenging yet critical.

We present a case of a 60-year-old female who presented with generalized edema, dyspnea, and cardiac/renal involvement, subsequently diagnosed with AL amyloidosis based on laboratory, imaging, bone marrow biopsy, and Congo red staining findings.

Following chemotherapy with bortezomib and cyclophosphamide, the patient experienced transient cardiac arrest, received an implantable cardioverter defibrillator, and subsequently developed massive ascites. Upon developing Pseudomonas guariconensis bacteremia, she progressed to septic shock requiring intensive care unit admission, mechanical ventilation, vasopressor support, and targeted antimicrobial therapy. Through aggressive supportive care and source control, hemodynamic stabilization was achieved, allowing successful extubation and transfer to the general ward.

Superimposed sepsis on severe, multi-organ amyloidosis significantly complicates diagnosis and management. High clinical vigilance, early infection recognition, and prompt targeted therapy are essential to prevent fatal outcomes in patients with preexisting chronic organ dysfunctions.