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An 84-year-old man was admitted with a 1-year history of recurrent falls, diarrhoea and haemoptysis. He described a poor appetite for a number of years and over the last 9 months had experienced dysphagia with worsening anorexia and significant weight loss of 25 kg over the last 6 months. His deteriorating condition was compounded by ongoing type II diabetes mellitus and a past history of treated pulmonary tuberculosis, 40 pack-years of cigarette use and prostate cancer treated with radiotherapy. Ten days later he developed complete heart block and required a temporary pacemaker. The patient had a cardiac arrest due to electromechanical dissociation and died within 14 days of this admission.
The diagnosis of amyloidosis was only established after an autopsy provided tissue for histochemical analysis. Amyloidosis is frequently diagnosed late in the disease course, with catastrophic consequences, particularly in the case of amyloid cardiomyopathy.