Undiagnosed light chain systemic amyloidosis: does it matter to anesthesiologists? -a case report-

Abstract

Light chain systemic amyloidosis is rare but may accompany laryngeal or pulmonary involvement, which may increase the risk in airway management. We present a case of a patient planned for resection of cervical epidural mass. The patient had face and neck ecchymoses and purpuras with an unknown cause. Mask ventilation and intubation were successful, but the operation was cancelled to evaluate bleeding from facial skin lesions. A diagnosis of light chain systemic amyloidosis prompted evaluation of involvement of other organs and treatment. This case shows the importance of preoperative evaluation and careful airway management in patients with systemic amyloidosis.

Curious case of raccoon eye under general anaesthesia

“…Raccoon eyes developing in perioperative period has been reported earlier in systemic amyloidosis of AL type. [ 3 4 ] Infiltration of amyloid fibrils in the blood vessel wall causes easy bleeding. [ 5 ] Deposits in the mesenchymal tissue of the tongue, larynx, tracheobronchial tree and lung parenchyma may present as macroglossia, odynophagia, dyspnoea, stridor, distal atelectasis and recurrent pneumonia in patients with amyloidosis, and hence, it can predispose to a difficult intubation.…”