A Case of Comorbidity with Somatoform Disorder and Primary AL Amyloidosis

Abstract

Amyloidosis covers a group of diseases that result from abnormal deposition of a particular protein, called amyloid, in various tissues of the body. After close examination in our hospital, we diagnosed amyloidosis in a 37-year-old man with variegated body symptoms who had previously been diagnosed with somatoform disorder. Early diagnosis is typically difficult because specific symptoms are scarce, and "over-comprehension" by medical staff delays the diagnosis of amyloidosis. The possibility remains that diseases with difficult definitive diagnosis as shown in this report remain hidden as "suspected somatoform disorder" referrals from primary-care physicians. Keeping in mind that primary care physicians may find some conditions difficult to diagnose, careful attention should paid not to overlook or misunderstand physical symptoms which can strengthen the capabilities of the psychiatrist in liaison psychiatry. In this case, because the patient also displayed a hysterical character and manner of action, physical symptoms from amyloidosis were considered to reinforce the somatoform disorder. Concomitant amyloidosis and somatoform disorder was assumed as the diagnosis in our hospital. In the medical treatment that we provided, definitive diagnosis of the disease was able to be obtained by carefully continuing the diagnostic work even after we had comprehended the characteristics and conflict situation of the patient. This case suggests that correct identification of "comprehension possibility" in psychiatric treatment requires careful attention.