A case of dyspnea and periorbital rash.

A 75-year-old woman presented with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and edema. Macroglossia, generalized petechiae, raccoon eyes sign, and peripheral neuropathy were present, and an echocardiogram showed cardiac dilatation and left ventricular systolic dysfunction. Rectal biopsy and immune fixation electrophoresis confirmed the diagnosis of AL amyloidosis.