Unusual presentation of transthyretin (ATTR) cardiac amyloidosis: A case report of pruritus as a possible initial symptom and challenging diagnosis.

Key Clinical Message: This case emphasizes the significance of cardiac amyloidosis as a potential diagnosis in individuals manifesting with lesion-free pruritus and normal liver tests. Abstract: Amyloidosis is a complex disorder in which misfolded proteins accumulate in various organs of the body. Cardiac amyloidosis (CA) can lead to heart failure, cardiac arrhythmia, sudden cardiac death, and deposition of proteins in coronary arteries. Diagnosing CA can be difficult, as the cardiac manifestations of amyloidosis can be similar to more prevalent etiologies. In addition, the accumulation of proteins in soft tissues, including the skin, can cause pruritus. In this paper, we present a 70-year-old man with generalized pruritus and no skin lesions, later diagnosed as CA after detecting ascites fluid. This case underscores the importance of considering amyloidosis in patients presenting with nonspecific symptoms, particularly those affecting the skin, and highlights the need for increased awareness of this disease among clinicians.

Only serum pepsinogen I and pepsinogen I/II ratio are specific and sensitive biomarkers for screening of gastric cancer.

Purpose We aimed to determine optimal cut-off points of plasma levels of ghrelin and serum levels of pepsinogen I, II, and their ratio for screening of gastric cancer (GC). Methods Blood samples were taken from 41 patients with confirmed gastric cancer along with 82 patients without malignancy. Serum levels of pepsinogen I and II, plus plasma levels of acylated ghrelin were measured using commercial ELISA kits. Results The case group had significant lower plasma levels of ghrelin, pepsinogen I, and pepsinogen I/II ratio in comparison to the control group (P<0.001). In the control group, there was significant higher serum pepsinogen I (P=0.028) and pepsinogen II (P=0.003) and lower pepsinogen I/II ratio (P=0.020) in males versus females; significantly higher serum pepsinogen II (P=0.047) and lower pepsinogen I/II ratio (P=0.030) in overweight compared to normal weight patients; and significantly lower pepsinogen I/II ratio (P=0.030) in smokers versus non-smoker. In the case group, there was only significantly lower pepsinogen I (P=0.006) in males versus females, and significantly lower plasma ghrelin (P=0.017) in overweight compared to normal weight patients. The characteristic curve analysis indicated that pepsinogen I at a cut-off of 70.95 µg/L and pepsinogen I/II ratio at cut-off of 2.99, had good sensitivity and specificity. Conclusions Just serums levels of pepsinogen I and the ratio of pepsinogen I/II can be used as biomarker to screen GC.