A case of 79 year-old man suffering from nephrotic syndrome, infiltrative c
ardiomyopathy and sensitive neuropathy of the lower limbs, associated with
biclonal gammopathy (IgG kappa and IgA lambda), is described There was a hi
story of non-insulin dependent diabetes mellitus and of two lung nodules co
nsidered as benign lesions on the basis of cytologic, hematologic and instr
umental examination. A rectal biopsy positive for amyloid deposition (Congo
red histology and immunofluorescence study) led to the diagnosis of AL amy
loidosis. Considering that the patient did not fulfill diagnostic criteria
for lymphoproliferative diaseases (myeloma, lymphoma or Waldenstrom's macro
glubulinemia), nor for secondary malignant paraproteinemia, a diagnosis of
idiopathic AL amyloidosis with biclonal gammopathy was made. Very few cases
of idiopathic AL amyloidosis with double component are reported in the lit
erature. Our review suggests that idiopathic AL amyloidosis with biclonal g
ammopathy is similar to idiopathic AL amyloidosis with monoclonal paraprote
inemia in terms of clinical features, response to therapy and prognosis. Fu
rther studies, however, are necessary to clarify the trite incidence and th
e clinical features of idopathic AL amyloidosis associated with biclonal ga
mmopathy.