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Life sciences · Journal article
Frontiers in Psychiatry · August 12, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of a 57-year-old man initially diagnosed with major depressive disorder whose condition was later found to be systemic amyloidosis with cardiac involvement. The case illustrates how diagnostic overshadowing and cognitive bias can delay recognition of multisystem disease presenting with depression-like symptoms, but provides no epidemiological or mechanistic evidence of frequency or causation.
Case report. One 57-year-old male patient presenting initially with major depressive episode; subsequently found to have systemic amyloidosis..
Patient initially diagnosed with major depressive episode; later confirmed to have systemic amyloidosis with cardiac involvement and acute decompensated heart failure on renal biopsy. Recurrent hypotension and syncope were initially attributed to psychiatric illness and medication effects before somatic diagnosis emerged. Clinical deterioration prompted reassessment and renal biopsy, which confirmed amyloidosis.
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Clinicians should maintain suspicion for systemic disease in patients presenting with depression-like symptoms accompanied by progressive physiological abnormalities such as orthostatic hypotension or syncope, and reassess for somatic etiologies as the clinical picture evolves. This case underscores the importance of interdisciplinary communication to avoid diagnostic anchoring bias.
A single case report illustrating diagnostic delay due to cognitive bias; raises awareness of a potential clinical problem but does not quantify prevalence, risk, or establish causation.
As stated by the source record.
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Clinicians should maintain suspicion for systemic disease in patients presenting with depression-like symptoms accompanied by progressive physiological abnormalities such as orthostatic hypotension or syncope, and reassess for somatic etiologies as the clinical picture evolves. This case underscores the importance of interdisciplinary communication to avoid diagnostic anchoring bias.
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Background The symptoms of depression may overlap with the early manifestations of systemic diseases, resulting in diagnostic masking. Amyloidosis is a multisystemic disease that has the potential to affect the heart, kidneys, nervous system, liver, lungs and intestines. Cardiac involvement is the leading cause of morbidity and mortality. As the symptoms of systemic amyloidosis can be non-specific and like those of a depressive episode in its early stages, there can be delays in diagnosis when patients are initially diagnosed depressed. Case presentation We report the case of a 57-year-old male patient who was initially diagnosed with a major depressive episode. During treatment, he developed recurrent episodes of hypotension and syncope, which were initially attributed to his psychiatric condition and medication-related factors. As his clinical condition progressively deteriorated, a renal biopsy was performed, which ultimately confirmed a diagnosis of systemic amyloidosis with cardiac involvement and acute decompensated heart failure. Conclusion This case suggests that, at the interface between psychiatry and somatic medicine, diagnostic overshadowing, anchoring bias, and fragmented care may jointly contribute to delayed recognition of systemic amyloidosis, particularly cardiac amyloidosis. In cases where patients present with depression-like manifestations, orthostatic hypotension, and nonspecific multisystem symptoms, clinicians should remain highly alert to persistently progressive physiological abnormalities and dynamically re-evaluate potential underlying somatic etiologies as new evidence emerges. Greater interdisciplinary awareness and reduced cognitive bias may help to reduce diagnostic delay and optimize multidisciplinary management. Further investigation is required to explain the mechanistic links between systemic amyloidosis and depressive symptoms.
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