{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T08:35:00Z","timestamp":1773995700174,"version":"3.50.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immunoglobulin light-chain (AL) amyloidosis is a rare systemic disease caused by the extracellular deposition of misfolded light chains. Nonspecific manifestations, especially those dominated by severe autonomic neuropathy, frequently delay diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A 68-year-old woman was admitted after five months of recurrent syncope. The clinical picture was dominated by refractory orthostatic hypotension, nausea and vomiting alternating with diarrhea and constipation, stocking-glove paresthesias, and proteinuria. Bone marrow examination showed the presence of clonal plasma cells with positive M protein, which was confirmed by the serum free light chain test. AL amyloidosis was diagnosed based on positive Congo red staining in renal biopsy specimens. The patient was enrolled in a daratumumab-based protocol combined with daratumumab, bortezomib, cyclophosphamide, and dexamethasone. After three cycles, complete hematological remission was achieved, and the autonomic nerve function improved gradually over the subsequent six months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case and literature review suggest that AL amyloidosis should be considered whenever a patient presents with multisystem dysfunction dominated by autonomic nerve dysfunction. Although such presentations are associated with poor prognosis, prompt initiation of daratumumab-based therapy can produce rapid hematologic remission and clinically meaningful improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1744590","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:22:41Z","timestamp":1773984161000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient with AL amyloidosis with recurrent syncope as the first symptom: case report and literature review"],"prefix":"10.3389","volume":"16","author":[{"given":"Lingling","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Hematology, Wuxi Branch of Ruijin Hospital Shanghai Jiao Tong University School of Medicine","place":["Wuxi, 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