2025 Volume 46 Issue 2 Pages 138-144
Systemic amyloidosis is a refractory disease characterized by the abnormal deposition of amyloid substances, composed mainly of unique fibrous proteins with a β-structure, in the extracellular spaces of various organs throughout the body, causing functional impairment. The patient was a 79-year-old male. His chief complaint was dysphagia. Due to the enlargement of tongue and poor tongue mobility, he was referred to our department and visited us. He was 169.2cm tall, weighed 49.9kg, and had poor nutritional status with TP at 6.2g/dl and albumin at 3.4g/dl. A tongue biopsy revealed eosinophilic fibrous material in the subepithelial connective tissue of the tongue, and immunostaining confirmed a diagnosis of amyloidosis. Therefore, a full-body examination was conducted. The full-body examination revealed carpal tunnel syndrome as a neurological symptom, and amyloid deposits were also found in bone marrow tissue and a skin biopsy, leading to a diagnosis of systemic amyloidosis. Due to the progressive and refractory nature of the disease, a dramatic improvement was not expected, but our department aimed to do its best to enhance the patient’s QOL as much as possible. Indirect training, such as oral care, articulation training, lip and cheek massage, and exercises to strengthen the tongue muscle, led to improved swallowing function, allowing the patient to enjoy consuming food orally. Additionally, professional oral care by a dental hygienist was frequently performed to prevent aspiration pneumonia. However, due to the restricted range of motion of the tongue and poor hyoid bone movement, despite all possible interventions, the patient’s overall condition deteriorated, and he passed away nine months after diagnosis. In cases presenting with non-neoplastic macroglossia, tongue movement disorders, and dysphagia, it is necessary to consider amyloidosis as a differential diagnosis.
