Esophageal stricture due to amyloidosis in plasma cell dyscrasia: A case report and review of literature

Table 1 Baseline laboratory workup of the patient

Parameter	Patient value	Reference range
Hemoglobin (g/dL)	11.1	12.0-15.0
Total leukocyte count (×103/mm3)	9.35	4.0-11.0
Neutrophils (%)	61.8	40-75
Platelet count (×103/mm3)	435	150-450
Total bilirubin (mg/dL)	0.56	0.2-1.2
Direct bilirubin (mg/dL)	-	0.0-0.3
AST (IU/L)	15	5-40
ALT (IU/L)	12	5-40
ALP (IU/L)	97	40-129
Total protein (g/dL)	7.8	6.0-8.3
Albumin (g/dL)	3.1	3.5-5.2
Sodium (mEq/L)	137	135-145
Potassium (mEq/L)	4.0	3.5-5.1
Urea (mg/dL)	20	15-45
Serum creatinine (mg/dL)	0.79	0.6-1.2
Serum calcium (mg/dL)	10.6	8.5-10.5
PT/INR (Sec)	15/1.4	11-13.5/0.8-1.1

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; PT: Prothrombin time; INR: International normalized ratio.

Table 2 Workup for plasma cell dyscrasia

Parameters	Patient value	Reference range
M-Spike	2.27 g/dL (27.8%) (present)	Present/absent
Serum free kappa light chain (mg/L)	16.14	3.3-19.4
Serum free lambda light chain (mg/L)	752.40	5.7-26.3
Free κ/λ ratio	0.02	0.26-1.65
Urine Bence Jones protein	Negative	Negative
Spot protein creatinine ratio	100	< 150 mg/g
Whole body PET-CT	Diffuse circumferential esophageal wall thickening (up to 7 mm) without significant FDG uptake, no hypermetabolic lesions seen elsewhere

FDG: ¹⁸F-fluorodeoxyglucose; PET-CT: Positron emission tomography-computed tomography.

Table 3 Selected previously published case reports and case series of esophageal amyloidosis

Ref.	Study type	Age, sex	Clinical presentation	Endoscopic findings	Type of amyloidosis	Treatment and outcome
Shatnawei et al[13]	Case report	70, male	Hematemesis, Dysphagia	Ulcerated mucosa	NR	Symptom resolution
Fujiya et al[18]	Case report	72, male	Asymptomatic, Incidental findings	Subepithelial lesion in proximal esophagus	AL (λ)-type localized esophageal amyloidosis	On close follow-up, no symptoms occurred
Ailawadi et al[17]	Case report	74, male	Dysphagia	Distal esophageal stricture and endoscopically normal mucosa, but a biopsy-positive lesion in the proximal esophagus	NR	Not reported
Merchant et al[21]	Case report	79, male	Dysphagia and weight loss	Fluid-filled esophagus; manometry: Type 2 achalasia	NR	Symptoms improved with peroral endoscopic myotomy
Ranjan et al[22]	Case report	65, female	Dysphagia	Endoscopy/barium swallow normal; manometry showed low-amplitude, non-propulsive contractions	Multiple myeloma	NR
Ng et al[23]	Case report	85, male	Dysphagia	Large globular mass in the posterior pharyngeal wall and esophageal inlet	ATTR variant	Expired
Bhavani et al[24]	Case report	44, female	Dysphagia	Post-cricoid stricture	NR	NR
Cowan et al[4]	Case series (n = 76; Esophageal: 6)	Male: 62%; age: 61 (median)	Weight loss, heart burn	NR	AL - systemic	Mortality in 4%
Palchaudhuri et al[25]	Case report	69, male	Acute food bolus obstruction	Stricture and ulceration in mid esophagus	NR	Expired
Kahi et al[26]	Case report	47/male	Dysphagia	Submucosal tumor-like lesion in the esophagus	AL (κ) - Amyloidosis	Stable, without treatment
Wongjarupong et al[27]	Case report	72/male	Dysphagia	Normal endoscopy; manometry: Type II achalasia	AL (κ), associated with multiple myeloma	Localized Botulinum toxin, partial improvement
Prokaeva et al[28]	Case report	66/male	Abdominal pain, weight loss	Multiple diminutive nodules in middle third of esophagus	Hereditary AApoAI, novel APOA1 p.Trp96Arg (W72R)	Observation/follow-up; no new organ involvement over approximately 6 years

AApoAI: Hereditary apolipoprotein A-I amyloidosis; AL: Amyloid light-chain; ATTR: Transthyretin amyloidosis; NR: Not reported.