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Miyake Z, Nakamagoe K, Ezawa N, Yoshinaga T, Hashimoto R, Sato T, Sekijima Y, Tamaoka A. Late-onset Transthyretin (TTR)-familial Amyloid Polyneuropathy (FAP) with a Long Disease Duration from Non-endemic Areas in Japan. Intern Med 2019; 58:713-718. [PMID: 30333406 PMCID: PMC6443558 DOI: 10.2169/internalmedicine.1457-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We herein report the case of an 84-year-old woman with transthyretin (TTR) Val30Met-associated familial amyloid polyneuropathy (FAP-ATTR Val30Met), representing a very old case. The patient had muscle weakness and sensory disturbances in her extremities caused by severe peripheral neuropathy. She also had vitreous opacity and orthostatic hypotension, and pyrophosphate scintigraphy showed a myocardial accumulation. Esophagogastroduodenoscopy revealed mucosal amyloid deposits, positive in anti-TTR antibody staining. A TTR gene analysis isolated the Val30Met mutation. More than a few cases of FAP-ATTR develop late, like our own, and their familial histories are often obscure in non-endemic areas, which might make a diagnosis difficult.
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Affiliation(s)
- Zenshi Miyake
- Department of Neurology, University of Tsukuba Hospital, Japan
| | - Kiyotaka Nakamagoe
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
| | - Naoki Ezawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Tsuneaki Yoshinaga
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | | | - Taiki Sato
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Akira Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Japan
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Hsu HC, Liao MF, Hsu JL, Lo AL, Kuo HC, Lyu RK, Wu VCC, Wang CW, Ro LS. Phenotypic expressions of hereditary Transthyretin Ala97Ser related Amyloidosis (ATTR) in Taiwanese. BMC Neurol 2017; 17:178. [PMID: 28882124 PMCID: PMC5590125 DOI: 10.1186/s12883-017-0957-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/30/2017] [Indexed: 01/15/2023] Open
Abstract
Background The disease course and early signs specific to ATTR Ala97Ser, the most common endemic mutation in Taiwan, have not been well described. Since new medications can slow down the rate of disease progression, the early diagnosis of this heterogeneous and fatal disease becomes critical. Methods We retrospectively reviewed the characteristics of genetically confirmed ATTR Ala97Ser patients at a tertiary referral medical center. Results Eight patients from 7 different families were enrolled (61.7 ± 5.5 years). Gastrointestinal symptoms, dyspnea or chest tightness, rather than sensory symptoms, were the initial symptoms in two patients (2/7 = 29%). Body weight loss (3/7 = 43%), muscle wasting (4/7 = 57%), or dysphagia (3/7 = 43%) were the consecutive symptoms. Orthostatic symptoms including orthostatic hypotension (7/7 = 100%), dizziness (6/7 = 86%) and syncope (5/7 = 71%) tended to develop in the late phase of the disease. Autonomic dysfunction was conspicuous. Cardiographic findings included a combination of ventricular wall thickening and pericardial effusion (7/7 = 100%), a granular sparkling appearance of the ventricular myocardium (4/7 = 57%), or conduction abnormalities (5/7 = 71%). Conclusions This study broadens the recognition of the initial signs and symptoms, including cardiographic findings and longitudinal manifestations in Taiwanese individuals with ATTR Ala97Ser mutation. These manifestations should prompt doctors to perform further studies and make an early diagnosis. Electronic supplementary material The online version of this article (10.1186/s12883-017-0957-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui-Ching Hsu
- Department of Traditional Chinese Medicine, Division of Chinese Acupuncture and Traumatology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan, Republic of China
| | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.199, Tung Hwa N. Rd., Songshan Dist, Taipei City, 105, Taiwan, Republic of China
| | - Jung-Lung Hsu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.199, Tung Hwa N. Rd., Songshan Dist, Taipei City, 105, Taiwan, Republic of China
| | - Ai-Lun Lo
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.199, Tung Hwa N. Rd., Songshan Dist, Taipei City, 105, Taiwan, Republic of China
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.199, Tung Hwa N. Rd., Songshan Dist, Taipei City, 105, Taiwan, Republic of China
| | - Rong-Kuo Lyu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.199, Tung Hwa N. Rd., Songshan Dist, Taipei City, 105, Taiwan, Republic of China
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan, Republic of China
| | - Chih-Wei Wang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333, Taiwan, Republic of China
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, No.199, Tung Hwa N. Rd., Songshan Dist, Taipei City, 105, Taiwan, Republic of China.
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