A Woman with Abdominal Distention, Edema, and Pleural Effusion

An 82-year-old woman with a history of heart failure with preserved ejection fraction presented with progressive anasarca following a trip to South America. Notable findings included pitting edema and jugular venous distension on examination, as well as hypoalbuminemia, proteinuria, and abnormal serum protein electrophoresis. Her clinical picture raised concern for a systemic process, ultimately prompting a kidney biopsy.