Most common initial symptoms of systemic AL amyloidosis
- • Fatigue (54%).
- • Weight loss (42%).
- • Pain (15%).
- • Purpura (16%).
- • Gross bleeding (8%).
Diagnosis is often delayed as a result of the nonspecific nature of the symptoms. Weight loss can be striking, exceeding 40 lbs (18.1 kg) in some patients and prompting a search for occult malignancy. Pain is more common in those with myeloma (40%) than those without (8%). In those without myeloma, pain is frequently attributable to peripheral neuropathy (10%) and/or carpal tunnel syndrome (CTS; 20%). Other symptoms are often present in patients with specific organ involvement including edema from nephrotic syndrome due to renal involvement; dyspnea on exertion and edema due to a restrictive cardiomyopathy; abdominal discomfort from hepatosplenomegaly; seronegative arthropathy resembling RA; painful paresthesias with peripheral neuropathy; orthostasis, syncope, impotence, and gut dysmotility resulting from autonomic neuropathy.
