We report a case of a 44-year-old woman who developed progressive dysphagia and shoulder stiffness, ultimately leading to a diagnosis of multiple myeloma (MM) with systemic light-chain (AL) amyloidosis. Despite intensive systemic therapy for MM with good serological response and nine months of comprehensive swallowing rehabilitation, her tongue mobility remained severely restricted, with only minimal improvement in laryngeal elevation. Videofluoroscopic swallowing study (VFSS) confirmed poor tongue control, reduced laryngeal elevation, and penetration of thin liquids. She ultimately passed away despite hematologic control. This case underscores the profound impact of amyloid deposition on swallowing function, even in the context of medically controlled MM and AL amyloidosis combined with prolonged swallowing intervention. The suboptimal recovery suggests that amyloid infiltration may cause irreversible structural and neuropathic damage, limiting functional restoration. In such patients, dysphagia management may need to prioritize compensatory strategies and quality of life rather than curative rehabilitation.
Jeng et al. (Wed,) studied this question.