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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr06.2009.2032.
Published online Mar 8, 2010. doi:  10.1136/bcr.06.2009.2032
PMCID: PMC3027510
Rare disease
Restrictive cardiomyopathy in inherited ATTR amyloidosis (TTR-Ser23Asn) in a patient of German-Italian extraction
Iris I Mueller,1 Meinrad Gawaz,1 Reinhold P Linke,2 Christine Zuern,1 Dagmar Steiner,3 Klaus Altland,4 Nicolas Von Beckerath,5 and Hans-Joerg Weig1
1Medizinische Klinik Universitaetsklinikum Tuebingen, Kardiologie, Otfried-Mueller-Str. 10, Tuebingen, 72076, Germany
2Reference Center of Amyloid Diseases, amYmed, Am Klopferspitz 18a, Martinsried, 82152, Germany
3Klinik für Nuklearmedizin, Klinikum der Justus-Liebig-Universität, Friedrichstr. 25, Giessen, 35392, Germany
4Institut für Humangenetik, Justus-Liebig-Universität, Schlangenzahl 14, Giessen, 35392, Germany
5Deutsches Herzzentrum München, Lazarettstraße 36, Muenchen, 80636, Germany
Correspondence to Christine Zuern, christine.zuern/at/
Amyloidosis occurs when certain soluble proteins are transformed into amyloid fibrils in the extracellular space. Most common are the light-chain amyloidoses; less common is the AA-amyloidosis, which follows chronic inflammatory diseases, and the amyloidoses of transthyretin (TTR) origin. We report on a women of Italian-German origin with the mutation TTR (Ser23Asn). Whole body scintigraphy using TC99m-DPD showed end stage hereditary amyloidosis caused by ATTR with predominant tracer retention in the myocardium. Myocardial biopsies revealed the presence of amyloid by Congo red staining. Further immunohistochemical analysis showed ATTR amyloidosis. DNA sequencing revealed a point mutation of the transthyretin gene leading to a single amino acid substitution. The only effective treatment in patients with manifest cardiac ATTR amyloidosis is combined heart and liver transplantation. Our patient was placed on a list for this procedure, but unfortunately she died during the standby procedure due to urosepsis.
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