Incidental acute cholecystitis as a gateway to the diagnosis of AL cardiac amyloidosis

Amyloid light-chain (AL) amyloidosis is characterized by the deposition of amyloid fibrils in various organs, although gallbladder involvement is rare. We present the case of a 62-year-old female patient initially diagnosed with heart failure with preserved ejection fraction (HFpEF), who incidentally developed acute cholecystitis during her evaluation for HFpEF. Following a cholecystectomy, amyloid deposits were identified in the resected gallbladder. Subsequent investigations confirmed cardiac amyloidosis through imaging, bone marrow analysis, and M-protein detection, leading to a diagnosis of AL λ amyloidosis associated with multiple myeloma. The patient favorably responded to chemotherapy. This case emphasizes the importance of considering gallbladder amyloidosis, which may aid in avoiding unnecessary biopsies and facilitate timely diagnosis and treatment of amyloidosis.

Learning objective

Gallbladder amyloidosis is rare. However, recognizing that the gallbladder may be a site of amyloid deposition is crucial in cardiac amyloidosis management. This awareness can help clinicians avoid unnecessary biopsies by considering the gallbladder as a potential source of diagnostic tissue.