Abstract
We report an autopsy case of a systemic amyloidosis patient who was treated with hemodialysis due to chronic renal failure for 8 years and 7 months. The woman received the first hemodialysis treatment when she was 60 years old. After 6 months, she required implantation of a permanent pacemaker for the treatment of sick sinus syndrome, but pacing failure often occurred. Five months later, she underwent cholecystectomy with liver biopsy, which demonstrated the deposition of amyloid (AA) in the liver tissue. The diagnosis of secondary amyloidosis associated with chronic cholecystitis was thus made. She was hospitalized 12 times because of complications such as pacing failure, congestive heart failure and shunt occlusion. Hypotension was sometimes too serious for hemodialysis to be continued. It was suggested that the hypotension was due to the decrease in cardiac output and peripheral vascular resistance. Itching persisted in spite of treatment, and the deposition of amyloid was demonstrated in one of three skin biopsies.
The patient died when she was 69 years old, and it was found by autopsy that the pacemaker had perforated through the right ventricular wall.
