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Oral amyloidose er sjælden, men kan være første manifestation af systemisk AL amyloidose. Tandlæger bør være opmærksomme på makroglossi og uforklaret dysfagi som potentielle alarmsymptomer.
Kasuistik
DATO:
Dansk
English
Baggrund
Makroglossi forårsaget af systemisk AL-amyloidose er en sjælden, men alvorlig årsag til synkebesvær og vægttab. Tidlig diagnose er afgørende for prognosen.
Patienttilfælde
En 92-årig kvinde blev henvist med to års progredierende dysfagi og 20 kg vægttab. Omfattende medicinsk udredning var uden forklaring. Øre-næse-hals-undersøgelse viste en forstørret, fast tunge. Biopsi med Congo rød-farvning påviste amyloid, immunhistokemisk foreneligt med AL-amyloidose (lambda-type). Supplerende udredning bekræftede systemisk sygdom med kardiel og renal involvering. Patienten blev sat i kombination skemoterapi, med klinisk bedring.
Konklusion
Oral amyloidose er sjælden, men kan være første manifestation af systemisk AL amyloidose. Tandlæger bør være opmærksomme på makroglossi og uforklaret dysfagi som potentielle alarmsymptomer.
Klinisk relevans:
Forstørret og fast tunge kan være første kliniske tegn på systemisk AL amyloidose. Da oral amyloidose i langt de fleste tilfælde er udtryk for systemisk sygdom, kan tandlæger spille en afgørende rolle i tidlig diagnostik ved at reagere på uforklaret makroglossi, synkebesvær og vægttab.
forfattere
Bahareh B. Philipsen
overlæge, speciallæge, Øre-, Næse- og Halskirurgisk Afdeling, Odense Universitetshospital
