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Nakajima M, Watanabe K, Ohara Y, Otsuki M, Wakasa T, Tsuruta D, Oiso N. Hyperpigmentation with droplets of melanocytes into the dermis in primary localized cutaneous amyloidosis. J Dermatol 2024; 51:e72-e73. [PMID: 37789690 DOI: 10.1111/1346-8138.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/27/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Maki Nakajima
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Keiko Watanabe
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Yushiro Ohara
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Mai Otsuki
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Tomoko Wakasa
- Department of Diagnostic Pathology, Kindai University Nara Hospital, Ikoma, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka Metropolitan University School of Medicine, Osaka, Japan
| | - Naoki Oiso
- Department of Dermatology, Kindai University Nara Hospital, Ikoma, Japan
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Cohen OC, Blakeney IJ, Law S, Ravichandran S, Gilbertson J, Rowczenio D, Mahmood S, Sachchithanantham S, Wisniowski B, Lachmann HJ, Whelan CJ, Martinez-Naharro A, Fontana M, Hawkins PN, Gillmore JD, Wechalekar AD. The experience of hereditary apolipoprotein A-I amyloidosis at the UK National Amyloidosis Centre. Amyloid 2022; 29:237-244. [PMID: 35502644 DOI: 10.1080/13506129.2022.2070741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hereditary apolipoprotein A-I (AApoAI) amyloidosis is a rare heterogeneous disease with variable age of onset and organ involvement. There are few series detailing the natural history and outcomes of solid organ transplantation across a range of causative APOA1 gene mutations. METHODS We identified all patients with AApoAI amyloidosis who presented to the National Amyloidosis Centre (NAC) between 1986 and 2019. RESULTS In total, 57 patients with 14 different APOA1 mutations were identified including 18 patients who underwent renal transplantation (5 combined liver-kidney (LKT) and 2 combined heart-kidney (HKT) transplants). Median age of presentation was 43 years and median time from presentation to referral was 3 (0-31 years). Involvement of the kidneys, liver and heart by amyloid was detected in 81%, 67% and 28% of patients, respectively. Renal amyloidosis was universal in association with the most commonly identified variant (Gly26Arg, n = 28). Across all variants, patients with renal amyloidosis had a median creatinine of 159 µmol/L and median urinary protein of 0.3 g/24 h at the time of diagnosis of AApoAI amyloidosis and median time from diagnosis to end-stage renal disease was 15.0 (95% CI: 10.0-20.0) years. Post-renal transplantation, median allograft survival was 22.0 (13.0-31.0) years. There was one early death following transplantation (infection-related at 2 months post-renal transplant) and no episodes of early rejection leading to graft failure. Liver transplantation led to regression of amyloid in all four cases in whom serial 123I-SAP scintigraphy was performed. CONCLUSIONS AApoAI amyloidosis is a slowly progressive disease that is challenging to diagnose. The outcomes of transplantation are encouraging and graft survival is excellent.
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Affiliation(s)
- Oliver C Cohen
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Iona J Blakeney
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Steven Law
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Janet Gilbertson
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Shameem Mahmood
- National Amyloidosis Centre, University College London, London, United Kingdom
- University College Hospital, London, United Kingdom
| | - Sajitha Sachchithanantham
- National Amyloidosis Centre, University College London, London, United Kingdom
- University College Hospital, London, United Kingdom
| | - Brendan Wisniowski
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Carol J Whelan
- National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - Marianna Fontana
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, London, United Kingdom
- University College Hospital, London, United Kingdom
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Yadav A, Yadav P, Chander R. Primary Localized Cutaneous Amyloidosis Secondary to Sand Rubbing in a Wrestler. Skinmed 2022; 20:141-143. [PMID: 35532770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 40-year-old male, wrestler since 15 years of age presented with asymptomatic hyperpigmentation over both his both upper extremities for 10 years. There was no history of preceding itching or redness; of using a nylon brush, scrubbers, or sponges during bathing; or of excessive towel rubbing after bathing and applying cosmetics; however, he had been rubbing sand over both arms for 15 years. He had no personal or family history of atopy, diabetes, or thyroid disease. Cutaneous examination revealed the presence of symmetrical sharply defined reticulate brownish hyperpigmentation over both arms and favoring the left (Figure 1). Dermatoscopy revealed multiple uniform small brown fine streaks radiating from the center becoming reticulated (Figure 2). Hematologic and biochemical studies, in particular thyroid studies, were normal. Histopathologic examination revealed an amorphous eosinophilic deposit in the papillary dermis suggestive of macular amyloidosis (MA) (Figure 3). Methyl violet stain revealed amyloid positive areas (Figure 4), and a diagnosis of MA was made. With the cessation of the sand rubbing and the application of tacrolimus ointment (0.1%), the lesions slowly diminished. (SKINmed. 2022;20:141-143).
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Affiliation(s)
- Anuja Yadav
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Sucheta Kriplani Hospital, Delhi, India
| | - Pravesh Yadav
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Sucheta Kriplani Hospital, Delhi, India;
| | - Ram Chander
- Department of Dermatology and Sexually Transmitted Diseases, Lady Hardinge Medical College and Sucheta Kriplani Hospital, Delhi, India
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4
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Najafian N, Weber AT, Zuckerman JE, Zhang S, Saab S, Choi G. AL Lambda Amyloidosis Activates Acute Liver Failure in the Absence of Plasma Cell Dyscrasia. Dig Dis Sci 2022; 67:67-70. [PMID: 34655012 DOI: 10.1007/s10620-021-07253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/09/2022]
Abstract
A patient with systemic amyloidosis developed portal hypertension, acute liver failure and multiorgan dysfunction. Extensive testing was unrevealing for paraproteinemia, plasma cell dyscrasia, infectious, or inflammatory conditions. He was transferred to our institution for orthotopic liver transplant evaluation but was ultimately declined given clinical instability and dysautonomia. Post-mortem evaluation revealed extensive amyloid deposition in multiple organs determined to be AL-lambda amyloidosis.
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Affiliation(s)
- Nilofar Najafian
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Andrew T Weber
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jonathan E Zuckerman
- Departments of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sarah Zhang
- Departments of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sammy Saab
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
- Departments of Nursing, University of California at Los Angeles, Los Angeles, CA, USA.
- Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.
| | - Gina Choi
- Departments of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Departments of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
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5
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Minnella AM, Rissotto R, Antoniazzi E, Di Girolamo M, Luigetti M, Maceroni M, Bacherini D, Falsini B, Rizzo S, Obici L. Ocular Involvement in Hereditary Amyloidosis. Genes (Basel) 2021; 12:955. [PMID: 34206500 PMCID: PMC8304974 DOI: 10.3390/genes12070955] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022] Open
Abstract
The term amyloidosis describes a group of rare diseases caused by protein conformation abnormalities resulting in extracellular deposition and accumulation of insoluble fibrillar aggregates. So far, 36 amyloid precursor proteins have been identified, and each one is responsible for a specific disease entity. Transthyretin amyloidosis (ATTRv) is one of the most common forms of systemic and ocular amyloidosis, due to the deposition of transthyretin (TTR), which is a transport protein mainly synthesized in the liver but also in the retinal pigment epithelial cells. ATTRv amyloidosis may be misdiagnosed with several other conditions, resulting in a significant diagnostic delay. Gelsolin and keratoepithelin are other proteins that, when mutated, are responsible for a systemic amyloid disease with significant ocular manifestations that not infrequently appear before systemic involvement. The main signs of ocular amyloid deposition are in the cornea, irido-corneal angle and vitreous, causing complications related to vasculopathy and neuropathy at the local level. This review aims at describing the main biochemical, histopathological and clinical features of systemic amyloidosis associated with eye involvement, with particular emphasis on the inherited forms. We discuss currently available treatments, focusing on ocular involvement and specific ophthalmologic management and highlighting the importance of a prompt treatment for the potential sight-threatening complications derived from amyloid deposition in ocular tissues.
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Affiliation(s)
- Angelo Maria Minnella
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Roberta Rissotto
- Eye Clinic, San Paolo Hospital, University of Milan, 20142 Milan, Italy
| | - Elena Antoniazzi
- Institute of Ophthalmolgy, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marco Di Girolamo
- Former Director “Presidio Ambulatoriale per le Amiloidosi Sistemiche” Fatebenefratelli “San Giovanni Calibita” Hospital, 00135 Rome, Italy;
| | - Marco Luigetti
- Fondazione Policlinico A. Gemelli IRCCS. UOC Neurologia, 00168 Rome, Italy;
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Martina Maceroni
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
| | - Daniela Bacherini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, 50139 Florence, Italy;
| | - Benedetto Falsini
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Stanislao Rizzo
- Dipartimento Universitario Testa-Collo Rgani di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.M.M.); (M.M.); (B.F.); (S.R.)
- UOC Oculistica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
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Potrč M, Volk M, de Rosa M, Pižem J, Teran N, Jaklič H, Maver A, Drnovšek-Olup B, Bollati M, Vogelnik K, Hočevar A, Gornik A, Pfeifer V, Peterlin B, Hawlina M, Fakin A. Clinical and Histopathological Features of Gelsolin Amyloidosis Associated with a Novel GSN Variant p.Glu580Lys. Int J Mol Sci 2021; 22:ijms22031084. [PMID: 33499149 PMCID: PMC7865823 DOI: 10.3390/ijms22031084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Gelsolin amyloidosis is a rare autosomal dominant genetic disease, which typically affects the cornea, skin and sometimes other organ systems and is caused by mutations in a gene coding for gelsolin protein (GSN). We describe a novel mutation of GSN gene, p.Glu580Lys, associated with gelsolin amyloidosis in six members of a two-generation family, who exhibited lattice corneal dystrophy, loose facial skin and irregular heart rhythm. In one patient we reported optic nerve impairment, which is possibly a novel feature associated with gelsolin amyloidosis. Abstract Gelsolin amyloidosis typically presents with corneal lattice dystrophy and is most frequently associated with pathogenic GSN variant p.Asp214Asn. Here we report clinical and histopathological features of gelsolin amyloidosis associated with a novel GSN variant p.Glu580Lys. We studied DNA samples of seven members of a two-generation family. Exome sequencing was performed in the proband, and targeted Sanger sequencing in the others. The heterozygous GSN variant p.Glu580Lys was identified in six patients. The patients exhibited corneal dystrophy (5/6), loose skin (5/6) and/or heart arrhythmia (3/6) and one presented with bilateral optic neuropathy. The impact of the mutation on the protein structure was evaluated in silico. The substitution is located in the fifth domain of gelsolin protein, homologous to the second domain harboring the most common pathogenic variant p.Asp214Asn. Structural investigation revealed that the mutation might affect protein folding. Histopathological analysis showed amyloid deposits in the skin. The p.Glu580Lys is associated with corneal dystrophy, strengthening the association of the fifth domain of gelsolin protein with the typical amyloidosis phenotype. Furthermore, optic neuropathy may be related to the disease and is essential to identify before discussing corneal transplantation.
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Affiliation(s)
- Maja Potrč
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (B.D.-O.); (A.G.); (V.P.); (M.H.)
| | - Marija Volk
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.V.); (N.T.); (H.J.); (A.M.); (B.P.)
| | - Matteo de Rosa
- Institute of Biophysics, National Research Council, 20133 Milano, Italy; (M.d.R.); (M.B.)
- Department of Biosciences, University of Milano, 20133 Milano, Italy
| | - Jože Pižem
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Nataša Teran
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.V.); (N.T.); (H.J.); (A.M.); (B.P.)
| | - Helena Jaklič
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.V.); (N.T.); (H.J.); (A.M.); (B.P.)
| | - Aleš Maver
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.V.); (N.T.); (H.J.); (A.M.); (B.P.)
| | - Brigita Drnovšek-Olup
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (B.D.-O.); (A.G.); (V.P.); (M.H.)
| | - Michela Bollati
- Institute of Biophysics, National Research Council, 20133 Milano, Italy; (M.d.R.); (M.B.)
- Department of Biosciences, University of Milano, 20133 Milano, Italy
| | - Katarina Vogelnik
- Department of Neurology, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Ana Gornik
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (B.D.-O.); (A.G.); (V.P.); (M.H.)
| | - Vladimir Pfeifer
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (B.D.-O.); (A.G.); (V.P.); (M.H.)
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.V.); (N.T.); (H.J.); (A.M.); (B.P.)
| | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (B.D.-O.); (A.G.); (V.P.); (M.H.)
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.P.); (B.D.-O.); (A.G.); (V.P.); (M.H.)
- Correspondence:
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Florian A, Bietenbeck M, Chatzantonis G, Hüsing-Kabar A, Schmidt H, Yilmaz A. Regression of cardiac amyloid load documented by cardiovascular magnetic resonance in a patient with hereditary amyloidosis. Clin Res Cardiol 2020; 109:949-956. [PMID: 32048001 PMCID: PMC7308258 DOI: 10.1007/s00392-020-01611-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/29/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Anca Florian
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Grigorios Chatzantonis
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Anna Hüsing-Kabar
- Department of Gastroenterology/Hepatology, University Hospital Münster, Münster, Germany
| | - Hartmut Schmidt
- Department of Gastroenterology/Hepatology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
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García-Arpa M, Herrera-Montoro V, Gómez-Torrijos E. Pruritic Hyperkeratotic Papules on the Legs of a Patient with Atopic Dermatitis. Am Fam Physician 2020; 101:689-690. [PMID: 32463639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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9
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García Franco R, Arias Gómez A, García Roa M, Ramírez Neria P, Corredor Casas S. Vitreous amyloidosis as primary manifestation of disease: case report. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:244-247. [PMID: 32145978 DOI: 10.1016/j.oftal.2019.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
A 35-year-old woman with progressive decrease of vision in both eyes and with no other associated symptoms, manifested as the only antecedent, the death of her brother due to amyloidosis. The visual acuity was counting fingers at 30 centimetres in the right eye and 20/70 in the left eye. In ophthalmoscopy of the right eye, a white, homogeneous vitreous, that was difficult to assess in detail, was observed, and in the left eye a whitish vitreous with band-like opacities in the cortical region. Vitrectomy was performed in the right eye, and a study with specific stains showed positive for amyloid material. A case is reported of amyloidosis diagnosed with specific stains in a vitreous sample for which the initial and only manifestation was the presence of vitreous opacities. The processing of these samples should be considered in patients with family history, early vitreous opacities, negative results of systemic biopsy, or atypical course of the disease.
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Affiliation(s)
- R García Franco
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
| | - A Arias Gómez
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México.
| | - M García Roa
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
| | - P Ramírez Neria
- Departamento de Retina y Vítreo, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
| | - S Corredor Casas
- Departamento de Patología, Instituto Mexicano de Oftalmología I.A.P, Santiago de Querétaro, México
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10
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Smithee A, Garcia A, Tschen J, Schmidt J. Primary Localized Cutaneous Nodular Amyloidosis in the Absence of Systemic Disease. Skinmed 2019; 17:131-133. [PMID: 31145068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 41-year-old man presented with an asymptomatic, slowly enlarging plaque on the lower aspect of his left cheek, present for approximately 4 months. His past medical history was remarkable for allergic rhinitis. Three years before, he had had a nearly identical lesion surgically excised by Mohs method at the same site. On examination, there was a waxy, yellowish plaque, measuring 2.1 cm × 1.0 cm on the left cheek in proximity to the oral commissure (Figure 1). A shave biopsy revealed an atrophic epidermis with nodular aggregates of eosinophilic material in the dermis (Figure 2). Higher magnification showed an inflammatory infiltrate composed largely of plasma cells, which stained positively for CD20 and κ light chains (Figure 3). Congo red staining confirmed the diagnosis of nodular amyloidosis (Figure 4).
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Affiliation(s)
- Adam Smithee
- University of Texas McGovern Medical School at Houston, Houston, TX;
| | - Andres Garcia
- University of Texas McGovern Medical School at Houston, Houston, TX
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11
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Smogorzewski JM, Rodriguez L, Young L. Symmetric lichen amyloidosis: an atypical location on the bilateral extensor surfaces of the arms. Cutis 2019; 103:E9-E10. [PMID: 31116822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jan M Smogorzewski
- Department of Dermatology, University of Southern California, Los Angeles, USA
| | | | - Lorraine Young
- Division of Dermatology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
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12
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Samuelsson K, Radovic A, Press R, Auranen M, Ylikallio E, Tyynismaa H, KäRppä M, Veteläinen M, Peltola N, Mellgren SI, Mygland Å, Tallaksen C, Andersen H, Terkelsen AJ, Fontain F, Hietaharju A. Screening for Fabry disease and Hereditary ATTR amyloidosis in idiopathic small-fiber and mixed neuropathy. Muscle Nerve 2019; 59:354-357. [PMID: 30246259 DOI: 10.1002/mus.26348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION In this study we assessed the value of genetic screening for Fabry disease (FD) and hereditary ATTR amyloidosis in patients with idiopathic small-fiber neuropathy (SFN) or mixed neuropathy in a clinical setting. METHODS This was a Nordic multicenter study with 9 participating centers. Patients with idiopathic SFN or mixed neuropathy were included. Genetic sequencing of the TTR and GLA genes was performed. RESULTS There were 172 patients enrolled in the study. Genetic screening was performed in 155 patients. No pathogenic mutations in the TTR gene were found. A single patient had a possible pathogenic variant, R118C, in the GLA gene, but clinical investigation showed no firm signs of FD. DISCUSSION Screening for hereditary ATTR amyloidosis and FD in patients with idiopathic SFN or mixed neuropathy without any additional disease-specific symptoms or clinical characteristics in a Nordic population appears to be of little value in a clinical setting. Muscle Nerve 59:354-357, 2019.
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Affiliation(s)
- Kristin Samuelsson
- Department of Clinical Neuroscience, Karolinska Institute, R54, Huddinge, 141 86, Stockholm, Sweden
| | - Ana Radovic
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Rayomand Press
- Department of Clinical Neuroscience, Karolinska Institute, R54, Huddinge, 141 86, Stockholm, Sweden
| | - Mari Auranen
- Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
| | - Emil Ylikallio
- Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
| | - Henna Tyynismaa
- Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
| | - Mikko KäRppä
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Matilda Veteläinen
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
| | - Niina Peltola
- Department of Neurology, Tampere University Hospital and Faculty of Medical and Life Sciences, University of Tampere, Tampere, Finland
| | - Svein Ivar Mellgren
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Åse Mygland
- Department of Neurology, Sørlandet Hospital, Kristiansand, Norway
| | - Chantal Tallaksen
- Department of Neurology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Freja Fontain
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Aki Hietaharju
- Department of Neurology, Tampere University Hospital and Faculty of Medical and Life Sciences, University of Tampere, Tampere, Finland
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Stull CM, Tey HL, Yosipovitch G. Methotrexate for the Treatment of Recalcitrant Primary Localized Cutaneous Amyloidosis: A Case Series. Acta Derm Venereol 2018; 98:900-901. [PMID: 29944169 DOI: 10.2340/00015555-2991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Soriano LF, McGrath C, Hawthorne M, Ekeowa-Anderson AL. An intensely pruritic pebbled presentation. Dermatol Online J 2018; 24:13030/qt6tp6f9c4. [PMID: 29630157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023] Open
Abstract
Lichen amyloidosis (LA) is a form of primary localized cutaneous amyloidosis (PLCA) characterized by bilateral intensely itchy domed scaly hyperkeratotic papules. Lichen amyloidosis is rare and affects men more than women. It is uncommonly seen in the western world but more prevalent in Asia. These papules most typically affect the shins and occasionally the arms and torso. Lichen amyloidosis has been reported in association with autoimmune disorders and after prolonged exfoliation and friction of affected skin. We present a 40-year-old woman with LA. In LA, the characteristic histological finding is apple-green birefringence of Congo red-stained preparations observed under polarized light. However, this is not always strongly positive, as in our patient. Other findings may include eosinophilia, periodic acid-Schiff positivity, staining with thioflavin T, and metachromasia after staining with crystal violet or methyl violet. Treatment of LA is difficult and complete clinical remission is seldom achieved. Recent trials revealed beneficial outcomes with topical calcipotriol, phototherapy, acitretin, cyclophosphamide, and laser treatments. A combination of acitretin, antihistamines, topical steroids, and hydrocolloid dressings have been beneficial in our patient with LA.
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Abstract
RATIONALE Apolipoprotein A-1 (ApoA-1)-related amyloidosis is characterized by the deposition of ApoA-1 in various organs and can be either hereditary or nonhereditary. It is rare and easily misdiagnosed. Renal involvement is common in hereditary ApoA-1 amyloidosis, but rare in the nonhereditary form. PATIENT CONCERNS We reported two cases with ApoA-1 amyloidosis, a 64-year-old man suffering from nephrotic syndrome and a 40-year-old man with nephrotic syndrome and splenomegaly. Renal biopsies revealed glomerular, interstitial and vascular amyloid deposits and positive phospholipase A2 receptor staining in the glomerular capillary loop in case 1, and mesangial amyloid deposits in case 2. DIAGNOSES After immunostaining failed to determine the specific amyloid protein, proteomic analysis of amyloid deposits by mass spectrometry was performed and demonstrated the ApoA-1 origin of the amyloid. Genetic testing revealed no mutation of the APOA1 gene in case 1 but a heterozygous mutation, Trp74Arg, in case 2. Case 1 was thus diagnosed as nonhereditary ApoA-1 associated renal amyloidosis with membranous nephropathy, and case 2 as hereditary ApoA-1 amyloidosis with multiorgan injuries (kidney and spleen) and a positive family history. INTERVENTIONS Case 1 was treated with glucocorticoid combined with cyclosporine. Case 2 was treated with calcitriol and angiotensin converting enzyme inhibitors. OUTCOMES Two cases were followed up for 5 months and 2 years, respectively; and case 1 was found to have attenuated proteinuria while case 2 had an elevation of cholestasis indices along with renal insufficiency. LESSONS Proteomic analysis by mass spectrometry of the amyloid deposits combined with genetic analysis can provide accurate diagnosis of ApoA-1 amyloidosis. Besides, these 2 cases expand our knowledge of ApoA-1-related renal amyloidosis.
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16
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Gertz MA. Hereditary ATTR amyloidosis: burden of illness and diagnostic challenges. Am J Manag Care 2017; 23:S107-S112. [PMID: 28978215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hereditary transthyretin-mediated (hATTR) amyloidosis is a progressive disease characterized by deposition of amyloid fibrils in various organs and tissues of the body. There are a wide variety of clinical presentations for this multisystemic disorder, so it is often misdiagnosed or subject to delayed diagnosis. Although the exact prevalence is difficult to determine, existing estimates suggest a worldwide prevalence of 50,000 individuals, with varying phenotypic presentations of disease. Due to the heterogeneous nature of its presentation, incorrect or delayed diagnosis can severely impact quality of life for these patients. hATTR amyloidosis can lead to significant disability and mortality. After an accurate diagnosis of hATTR amyloidosis is established, new patients should undergo appropriate therapy as soon as possible. Current treatment options for hATTR amyloidosis are limited, but orthotopic liver transplant serves as an established option for patients with early-stage disease. Consequently, there is a need for new, effective, and safe therapies.
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Heng JK, Ho SA, Tan KB. Poikiloderma-like cutaneous amyloidosis--a rare presentation of primary localized cutaneous amyloidosis. Dermatol Online J 2016; 22:13030/qt20s8p7qt. [PMID: 26990468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023] Open
Abstract
Poikiloderma-like cutaneous amyloidosis (PCA) is a rare variant of primary cutaneous amyloidosis. It was first described in 1929 and there are two clinical forms of PCA, the ordinary type and PCA syndrome. The characteristics of PCA include poikiloderma-like skin changes, lichenoid papules, blister formation, and cutaneous amyloid deposits on histological examination. These skin lesions usually occur at the extremities, consistent with the few cases that have been reported. We present a case of a 62-year-old man who presented with the features of poikiloderma-like cutaneous amyloidosis. Diagnosis of this unique condition is a challenge and a skin biopsy is necessary in such instances. A discussion of the differential diagnosis of this condition is also included.
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White F, Shvartsbeyn M, Meehan SA, Ramachandran S. Nodular amyloidosis. Dermatol Online J 2015; 21:13030/qt6v26s4mn. [PMID: 26990345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 06/05/2023] Open
Abstract
Nodular amyloidosis is the rarest form of primary cutaneous amyloidosis. We report the case of a 74-year-old woman with an eight-year history of asymptomatic, hyperpigmented plaques on the pretibial areas. A skin biopsy specimen showed deposits of amorphous eosinophilic material that extended throughout the dermis with apple-green birefringence with a Congo-red stain, which established a diagnosis of nodular amyloidosis. Patients with nodular amyloidosis should be evaluated for systemic disease and followed appropriately due to a small risk of progression to systemic amyloidosis.
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Kanchanapoomi M, Rosenstein R, Shvartsbeyn M, Meehan SA, Dolly N, Femia A. Primary diffuse macular amyloidosis. Dermatol Online J 2015; 21:13030/qt54z8k8r6. [PMID: 26990346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 06/05/2023] Open
Abstract
We present a 53-year-old woman with diffuse macular amyloidosis. We discuss the clinical manifestations, pathophysiologic mechanisms, and associations of cutaneous macular amyloidosis.
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20
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Samillán-Sosa KDR, Sención-Martínez G, Lopes-Martín V, Martínez-González MA, Solé M, Arostegui JL, Mesa J, García-Díaz JDD, Rodríguez-Puyol D, Martínez-Miguel P. Hereditary apolipoprotein AI-associated renal amyloidosis: A diagnostic challenge. Nefrologia 2015; 35:322-7. [PMID: 26299174 DOI: 10.1016/j.nefro.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/05/2015] [Indexed: 11/19/2022] Open
Abstract
Hereditary renal amyloidosis is an autosomal dominant condition with considerable overlap with other amyloidosis types. Differential diagnosis is complicated, but is relevant for prognosis and treatment. We describe a patient with nephrotic syndrome and progressive renal failure, who had a mother with renal amiloidosis. Renal biopsy revealed amyloid deposits in glomerular space, with absence of light chains and protein AA. We suspected amyloidosis with fibrinogen A alpha chain deposits, which is the most frequent cause of hereditary amyloidosis in Europe, with a glomerular preferential affectation. However, the genetic study showed a novel mutation in apolipoprotein AI. On reviewing the biopsy of the patient's mother similar glomerular deposits were found, but there were significant deposits in the renal medulla as well, which is typical in APO AI amyloidosis. The diagnosis was confirmed by immunohistochemistry. Apo AI amyloidosis is characterized by slowly progressive renal disease and end-stage renal disease occurs aproximately 3 to 15 years from initial diagnosis. Renal transplantation offers an acceptable graft survival and in these patients with hepatorenal involvement simultaneous liver and kidney transplantation could be considered.
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Affiliation(s)
| | - Gloria Sención-Martínez
- Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Vanessa Lopes-Martín
- Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | - Manel Solé
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | | | - Jose Mesa
- Unidad de Genética Clínica, Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Juan de Dios García-Díaz
- Unidad de Genética Clínica, Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Diego Rodríguez-Puyol
- Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Patricia Martínez-Miguel
- Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
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21
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Zhai Z, Hao F, Song Z, Yang X. Primary localized cutaneous nodular amyloidosis of the thighs. Cutis 2015; 95:E24-E27. [PMID: 26125219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Primary localized cutaneous nodular amyloidosis (PLCNA) is a rare form of cutaneous amyloidosis. We report the case of a 65-year-old woman with multiple asymptomatic discrete nodules and atrophic plaques on the thighs of 4 years' duration that had increased in number and size. Results of extensive clinical, histologic, and laboratory evaluation showed no evidence of systemic amyloidosis or myeloma. A diagnosis of PLCNA was made. The patient refused treatment due to the asymptomatic nature of the lesions, and follow-up examination 2.5 years later showed minimal progression of the disease.
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Affiliation(s)
- Zhifang Zhai
- Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing, 400038 China.
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22
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Dousset L, Seneschal J, Boniface K, Charreau S, Ezzedine K, Milpied B, Mossalayi MD, McGrath JA, Lecron JC, Taïeb A. A Th2 cytokine interleukin-31 signature in a case of sporadic lichen amyloidosis. Acta Derm Venereol 2015; 95:223-4. [PMID: 24573820 DOI: 10.2340/00015555-1829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Léa Dousset
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin disorders, Hôpital Sain-André, 1 rue Jean Burguet, FR-33075 Bordeaux, France
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23
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Grönhagen CM, Tey HL. Primary localized cutaneous amyloidosis: a clinical diagnosis. Skinmed 2014; 12:257-258. [PMID: 25335358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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25
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Dehghani F, Ebrahimzadeh M, Moghimi M, Noorbala MT. Familial amyloidosis cutis dyschromica: a case report. Acta Med Iran 2014; 52:163-165. [PMID: 24659076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/18/2014] [Indexed: 06/03/2023] Open
Abstract
Amyloidosis cutis dyschromica (ACD) is a rare form of macular amyloidosis characterized by hypo and hyperpigmented macules. Here we described a 20 year old girl with diffuse hypo and hyperpigmentation since she was four years old. Five other members of her family are also involved. Biopsy of hyperpigmented lesions revealed increase of melanin in the basal layer, pigment incontinence and amorphous eosinophilic masses stained positive with Congo red in the papillary dermis. The histopathologic findings were consistent with amyloidosis cutis dyschromica. Other investigations were normal. Dermatologists should consider amyloidosis cutis dyschromica when visit a patient with diffuse hypo and hyperpigmentation.
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Affiliation(s)
- Farideh Dehghani
- Department of Dermatology, Shahid Sadooghi University of Medical Sciences, Yazd, Iran.
| | - Mohammad Ebrahimzadeh
- Department of Dermatology, Shahid Sadooghi University of Medical Sciences, Yazd, Iran.
| | - Mansour Moghimi
- Department of Pathology, Shahid Sadooghi University of Medical Sciences, Yazd, Iran.
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26
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Abstract
Pituicytoma is a rare low-grade (WHO grade I) sellar region glioma. Among sellar tumors, pituitary adenomas, mainly prolactinomas, may show amyloid deposits. Gelsolin is a ubiquitous calcium-dependent protein that regulates actin filament dynamics. Two known gene point mutations result in gelsolin amyloid deposition, a characteristic feature of a rare type of familial amyloid polyneuropathy (FAP), the Finnish-type FAP, or hereditary gelsolin amyloidosis (HGA). HGA is an autosomal-dominant systemic amyloidosis, characterized by slowly progressive neurological deterioration with corneal lattice dystrophy, cranial neuropathy, and cutis laxa. A unique case of pituicytoma with marked gelsolin amyloid deposition in a 67-year-old Chinese woman is described. MRI revealed a 2.6-cm well-circumscribed, uniformly contrast-enhancing solid sellar mass with suprasellar extension. Histologically, the lesion was characterized by solid sheets and fascicles of spindle cells with slightly fibrillary cytoplasm and oval nuclei with pinpoint nucleoli. Surrounding brain parenchyma showed marked reactive piloid gliosis. Remarkably, conspicuous amyloid deposits were identified as pink homogeneous spherules on light microscopy that showed apple-green birefringence on Congo red with polarization. Mass spectrometric-based proteomic analysis identified the amyloid as gelsolin type. Immunohistochemically, diffuse reactivity to S100 protein and TTF1, focal reactivity for GFAP, and no reactivity to EMA, synaptophysin, and chromogranin were observed. HGA-related mutations were not identified in the tumor. No recurrence was noted 14 months after surgery. To the knowledge of the authors, amyloid deposition in pituicytoma or tumor-associated gelsolin amyloidosis has not been previously described. This novel finding expands the spectrum of sellar tumors that may be associated with amyloid deposition.
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Affiliation(s)
- Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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27
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Ramalingam R, Kadako NS, Pati S, Manjunath CN. Large pericardial effusion :a clinical dilemma! J Assoc Physicians India 2013; 61:507-509. [PMID: 24772763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 55yr old gentleman known diabetic and hypertensive presented with breathlessness and tingling sensation of both upper and lower limbs with strong family history of similar neurological problems. On extensive evaluation he was found to have amyloidic peripheral neuropathy with large pericardial effusion. Tubercular etiology was confirmed by pericardial fluid PCR and culture. Here the diagnostic dilemma was whether Amloidosis is primary, secondary to Tubercular pericardial effusion or Hereditary Amyloidosis. In the end, how we have arrived at the diagnosis of Hereditary Amyloidosis based upon the strong family history and nerve biopsy is interestingly presented in the following case report.
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28
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Konopinski JC, Seyfer SJ, Robbins KL, Hsu S. A case of nodular cutaneous amyloidosis and review of the literature. Dermatol Online J 2013; 19:10. [PMID: 24021370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 04/14/2013] [Indexed: 06/02/2023] Open
Abstract
Nodular cutaneous amyloidosis (NCA) is the rarest form of primary cutaneous amyloidosis. The amyloid fibrils of NCA are not unique to NCA but are also the prevailing amyloid component in primary systemic amyloidosis (PSA) and myeloma-associated systemic amyloidosis. Age of presentation in NCA has ranged from 20 to 87 years without a clear gender predilection. Progression from NCA to primary systemic amyloidosis has been reported, with an estimated lifetime risk of approximately 7 percent, prompting the need for appropriate follow up to evaluate for the presence of systemic amyloidosis. We report a case of nodular cutaneous amyloidosis in an otherwise healthy 62-year-old woman and we review the literature.
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29
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Fradley MG, Thakuria JV, Collins AB, Moore SA, Stone JR. Direct tissue evaluation via immunofluorescence: in the diagnosis of hereditary transthyretin cardiac amyloidosis. Tex Heart Inst J 2012; 39:71-75. [PMID: 22412233 PMCID: PMC3298917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Multiple precursor proteins have been shown to cause cardiac amyloidosis. The most common forms are due either to immunoglobulin light chains or to transthyretin proteins (either wild-type or mutant forms). Correct subclassification of the amyloid is paramount because treatment differs in accordance with the type of amyloidosis. Indirect diagnostic methods, including serologic analysis, can lead to misdiagnosis. Definitive diagnosis often requires analysis of amyloid in the tissue. We present a case of a woman who was diagnosed with hereditary transthyretin cardiac amyloidosis by means of immunofluorescence and genetic analysis. This case highlights the importance-in the diagnostic algorithm of cardiac amyloidosis-of direct evaluation of the tissue with immunofluorescence and of genetic testing.
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Affiliation(s)
- Michael G Fradley
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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30
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Munar-Qués M, Viader-Farré C, Zabay-Becerril JM, Mulet-Ferrer JM. Early diagnosis and management of patients with familial ATTR amyloidosis receiving livers from asymptomatic variant TTR carriers. Amyloid 2011; 18:172-3. [PMID: 21774739 DOI: 10.3109/13506129.2011.594822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The possibility of a patient with familial ATTR amyloidosis receiving a liver from an asymptomatic variant TTR carrier is remote [corrected].However, in 2008, it was reported that this unlikely event occurred in a patient in Portugal. We report our protocol for early diagnosis and management of this entity.
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Abstract
Gelatinous drop-like corneal dystrophy (GDLD) was first reported in 1914 as a peculiar corneal dystrophy with an autosomal recessive inheritance mode. GDLD is rare in many countries, but relatively prevalent in Japan. The typical finding of GDLD is grayish, mulberry-like, protruding subepithelial depositions with a prominent hyperfluorescence of the cornea. Histologically, GDLD corneas are characterized by subepithelial amyloid depositions that were identified as lactoferrin by amino acid sequencing analysis. In 1998, the TACSTD2 gene was identified as a causative gene for this disease through a linkage analysis and a candidate gene approach. To date, 14 reports have demonstrated 21 mutations comprised of 9 missense, 6 nonsense, and 6 frameshift mutations from 9 ethnic back grounds. Currently, it is hypothesized that the loss of TACSTD2 gene function causes decreased epithelial barrier function, thereby facilitating tear fluid permeation into corneal tissue, the permeated lactoferrin then transforming into amyloid depositions via an unknown mechanism. For the visual rehabilitation of patients with GDLD, ophthalmologists currently employ various types of keratoplasties; however, almost all patients will experience a recurrence of the disease within a few years after such interventions. Wearing of a soft contact lens is sometimes considered as an alternative treatment for GDLD.
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Takigawa M, Hashimura K, Ishibashi-Ueda H, Yamada N, Kiso K, Nanasato M, Yoshida Y, Hirayama H. Annual electrocardiograms consistent with silent progression of cardiac involvement in sporadic familial amyloid polyneuropathy: a case report. Intern Med 2010; 49:139-44. [PMID: 20075578 DOI: 10.2169/internalmedicine.49.2703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Understanding the clinical characteristics of transthyretin familial amyloid polyneuropathy (TTR-FAP) is critical for early diagnosis and timely referral for liver transplantation. Here, we describe a 52-year-old man who had slight paresthesia for four years and whose final diagnosis of TTR-cardiac amyloidosis caused by sporadic FAP was delayed despite annual electrocardiography. Curative liver transplantation was postponed because of progressive cardiac involvement. This experience highlights the difficulties associated with diagnosing TTR-FAP, especially when it is sporadic, and underscores the importance of slight changes in ECG that could indicate FAP.
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Affiliation(s)
- Masateru Takigawa
- Cardiovascular Center, Department of Internal Medicine, Japanese Red Cross Society, Nagoya Daini Hospital, Nagoya.
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Abstract
The concentration range of plasma proteins exceeds the dynamic range of any single analytical method. It has been estimated that the concentration range of serum proteins exceeds ten orders of magnitude (1). Because of this, prior immunoselection of even abundant proteins facilitates the relative nonquantitative observations required to show structural abnormality in primary or in posttranslational structure. Determination of atypical proteins by mass measurement has been reported for genetic defects in glycosylation (2, 3) and for monitoring for transthyretin (TTR) defects (4). Here we describe a rapid method of purification and electrospray introduction of TTR into a mass spectrometer to detect mass changes due to amino acid substitutions. The method currently forms the basis for a clinical assay to ascertain TTR mutations resulting in amyloidosis.
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Affiliation(s)
- John F O'Brien
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
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35
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Ergüven M, Emeksiz C, Deveci M, Ozlü SG. Relation between microalbuminuria and gene mutations in familial Mediterranean fever. Turk J Pediatr 2008; 50:326-330. [PMID: 19014044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We aimed to investigate the urinary microalbumin level, which is a sensitive marker of glomerular function for establishing probable renal involvement in early stages of the disease in patients with familial Mediterranean fever (FMF), and to determine the relation between gene mutations of these cases and urinary microalbumin levels. Fifty patients with FMF who were admitted to our department and had been followed up in the pediatric rheumatology outpatient clinic for five years were included in the study. Diagnosis was based on Tel-Hashomer criteria. Gene mutations (M694V, V726A, M680I) and acute phase reactants were determined as supportive findings. Routine renal function tests with 24 hour urinary microalbumin levels and urinary microalbumin/creatinine ratios were evaluated. There was a statistically significant difference between the study and control groups in terms of microalbumin/creatinine ratios, whereas no difference was observed with respect to the other parameters. Comparison of subgroups (gene mutations) in terms of all parameters (age, age at diagnosis, duration of delay in treatment, glomerular filtration rate, tubular reabsorption of phosphorus, and microalbumin/creatinine ratios) showed no difference. We suggest measurement of urinary microalbumin levels at regular intervals in order to establish renal injury early and decrease related complications.
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Affiliation(s)
- Müferet Ergüven
- Department of Pediatrics, Ministry of Health Göztepe Training Hospital, Istanbul, Turkey
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Shokouhi G, Khosroshahi HT. Ardalan-Shoja-Kiuru syndrome--hereditary gelsolin amyloidosis plus retinitis pigmentosa. Nephrol Dial Transplant 2007; 23:1071; author reply 1071-2. [PMID: 17720986 DOI: 10.1093/ndt/gfm577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Scalvini T, Martini PR, Obici L, Tardanico R, Biasi L, Gregorini G, Scolari F, Merlini G. Infertility and Hypergonadotropic Hypogonadism as First Evidence of Hereditary Apolipoprotein A-I Amyloidosis. J Urol 2007; 178:344-8. [PMID: 17507040 DOI: 10.1016/j.juro.2007.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We report that primary infertility and hypergonadotropic hypogonadism in young patients may be caused by testicular amyloidosis and it is associated with the presence of a mutation in the apoA-I gene, resulting in the replacement of proline for leucine at residue 75 of the protein. MATERIALS AND METHODS Ten patients presenting with infertility, gynecomastia, decreased libido, erectile dysfunction or a family history of amyloidosis underwent clinical evaluation, hormone assays, semen analysis, ultrasonographic investigation of the testicles, testicular biopsy and DNA sequencing of the apoA-I gene. RESULTS All patients showed azoospermia and 9 had increased testicular volume. Massive amyloid deposition was observed in all testicular biopsies and the apoA-I mutation of replacement of proline for leucine at residue 75 of the protein was noted. Five patients showed hypergonadotropic hypogonadism and 5 had normal testosterone values with high gonadotropin levels. CONCLUSIONS Nonobstructive azoospermia and macro-orchidism with or without hypogonadism may be caused by hereditary apoA-I amyloidosis in young patients. Testicular amyloidosis can be the first manifestation of this systemic disease. Specific staining for amyloid deposits and genetic analysis of apoA-I mutations are recommended in young, infertile patients with macro-orchidism. Finally, surveillance in asymptomatic mutation carriers is suggested to evaluate the opportunity to implement sperm retrieval and start androgen replacement therapy when necessary.
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Affiliation(s)
- Tiziano Scalvini
- Department of Endocrinology and Andrology, Spedali Civili, Brescia, Italy
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Westermark P. [Systemic amyloidoses--new treatment methods make early and exact diagnosis more and more important]. Lakartidningen 2007; 104:1517-21. [PMID: 17550030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Per Westermark
- Institutionen för genetik och patologi, Rudbeck-laboratoriet, Uppsal Universitet.
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Abstract
PURPOSE OF REVIEW This review aims to summarize recent developments in the area of systemic amyloidoses with emphasis on pathologic diagnosis. RECENT FINDINGS In recent years, management of amyloidosis has shifted from a purely supportive approach to quite diverse, radical and aggressive treatments. The central issue is the understanding that treatment of systemic amyloidoses depends on the molecular type of the amyloid protein. In the United States and the Western world, AL-amyloidosis is the most prevalent type of systemic amyloidosis, but hereditary amyloidoses are being diagnosed with increasing frequency; genetics also plays a role in a subset of familial AA amyloidoses. The biggest challenge is in the diagnosis of AL-type with confidence and in differentiation of AL and hereditary amyloidoses. While careful clinico-pathologic correlation is recommended for all patients with amyloidosis, it is, in itself, not a substitute for amyloid typing. SUMMARY The diagnosis of the amyloid type ultimately depends on the examination of the amyloid protein within the deposits. The role of immunohistochemistry - the current standard of care in amyloid typing - is evolving with emergence of alternative biochemical methods. Amyloid, being essentially a protein disorder, presents an attractive venue for the application of proteomics methodologies, despite their inherent complexities.
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Affiliation(s)
- Maria M Picken
- Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Boujaoude J, Honein K, Hobeika E, Ghorra C, Ghorra P, Hobeika E. When does severe diarrhoea disclose a hereditary disease? Gut 2007; 56:342. [PMID: 17339243 PMCID: PMC1856794 DOI: 10.1136/gut.2006.093468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J Boujaoude
- Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
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Oğuz H, Safak MA, Demirci M, Arslan N. Familial primary localized laryngeal amyloidosis in two sisters. Kulak Burun Bogaz Ihtis Derg 2007; 17:283-286. [PMID: 18187988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Laryngeal amyloidosis is rare, accounting for less than 1% of all benign laryngeal tumors. Although familial primary localized amyloidosis has been reported in other parts of the body, no familial cases have been reported in the larynx. Primary localized laryngeal amyloidosis was detected in two sisters whose ages were 35 years and 38 years, respectively. In the elder patient, a previous endolaryngeal biopsy for symptoms of dysphonia yielded no pathologic findings. Laryngoscopic examination of the patient showed a significant submucosal accumulation at the level of ventricles and vocal folds. The younger sister had a complaint of hoarseness for five years. The results of endolaryngeal biopsies performed in both patients were reported as amyloidosis. Further evaluations were negative for systemic amyloidosis. No surgical intervention was considered. The patients were monitored for more than two years without any other coexisting disease.
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Affiliation(s)
- Haldun Oğuz
- Department of Otolaryngology, Ankara Training and Research Hospital, Ankara, Turkey.
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Abstract
PURPOSE To report the in vivo confocal microscopic findings of combined polymorphic amyloid degeneration and posterior crocodile shagreen and correlate these findings with clinical presentations and previous histopathologic analysis. METHODS Case reports with confocal microscopic analysis and literature review. RESULTS Three patients with bilateral corneal opacities presented to the Emory Eye Center Cornea Clinic for evaluation. The first patient, a 65-year-old woman, was noted to have bilateral, discrete, punctate, and filamentous refractile stromal opacifications that appeared to be concentrated in the deep stroma. The second patient, a 50-year-old man, had bilateral deep central stromal haze in a mosaic pattern with intervening cracklike clear zones. The third patient, an 80-year-old woman, had bilateral deep stromal deposits similar to patient 1 in addition to bilateral deep central stromal haze in a mosaic pattern with intervening cracklike clear zones similar to patient 2. Confocal microscopy showed bright, enhancing punctate lesions in the deep stroma and anterior stroma, with unaffected areas between these regions in patients 1 and 3, and central acellular opacification of irregular intensity with intermittent linear clear zones within the normal posterior stromal bed in cases 2 and 3. The first patient was diagnosed with isolated polymorphic amyloid degeneration, the second patient was diagnosed with isolated posterior crocodile shagreen, and the third patient was diagnosed with combined polymorphic amyloid degeneration and posterior crocodile shagreen. CONCLUSION These cases are, to our knowledge, the first to report confocal microscopic findings in isolated polymorphic amyloid degeneration and combined polymorphic amyloid degeneration with posterior crocodile shagreen.
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Affiliation(s)
- Maria Woodward
- Department of Ophthalmology, Emory University, Atlanta, GA, USA
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Röcken C, Ernst J, Hund E, Michels H, Perz J, Saeger W, Sezer O, Spuler S, Willig F, Schmidt HHJ. [Interdisciplinary guidelines for diagnosis and therapy of extracerebral amyloidosis: issued by the German Society of Amyloid Diseases e. V. (www.amyloid.de)]. ACTA ACUST UNITED AC 2006; 101:825-9. [PMID: 17039325 DOI: 10.1007/s00063-006-1110-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Christoph Röcken
- Institut für Pathologie Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin.
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Urban PP, Hertkorn C, Schattenberg JM, Gawehn J, Hägele S, Wunsch M, Altland K. Leptomeningeal familial amyloidosis: A rare differential diagnosis of leptomeningeal enhancement in MRI. J Neurol 2006; 253:1238-40. [PMID: 16990995 DOI: 10.1007/s00415-006-0169-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Accepted: 01/31/2006] [Indexed: 11/25/2022]
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Kristen AV, Meyer FJ, Perz JB, Schonland SO, Hundemer M, Hegenbart U, Singer R, Schnabel PA, Sack FU, Goldschmidt H, Katus HA, Dengler TJ. Risk stratification in cardiac amyloidosis: novel approaches. Transplantation 2006; 80:S151-5. [PMID: 16286895 DOI: 10.1097/01.tp.0000187111.00076.1a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Amyloidosis is a term for diseases with extracellular deposition of insoluble beta-fibrillar proteins in different organs. The heart is primarily involved in more than half of patients with immunoglobulin light-chain amyloidosis or hereditary amyloidosis and associated with poor prognosis. Different traditional diagnostic tools that have been described for risk stratification lack of sufficient sensitivity and specificity for patient survival. Until November 2004 in 50 consecutive patients with light chain amyloidosis and 15 patients with hereditary amyloidosis electrocardiography, echocardiography, Holter monitoring, cardiopulmonary exercise test, lung function testing, tilt-test, and laboratory investigations have been performed at our department. Cardiac amyloidosis was found in 32 patients. Interventricular septum (14.3+/-0.5 mm vs. 12.3+/-0.7 mm, P<0.05), plasma NT-proBNP (7154+/-2122 ng/l vs. 380+/-113 ng/l; P<0.01), cardiac Troponin T (0.105+/-0.030 vs. 0.019+/-0.010 microg/l; P<0.05) were increased in patients with cardiac amyloidosis as compared to patients light chain amyloidosis but no cardiac involvement. Maximal inspiratory (Pimax) and expiratory (Pemax) mouth pressure were decreased with CA compared to controls. Correlation of NT-proBNP and interventricular septum thickness (r=0.53, P=0.029) as well as and Pimax (r=0.72, P<0.01) or Pemax (r=0.69; P<0.01) was noticed. A correlation of grade of arrhythmias in Holter monitoring and syncopes was not observed. Cardiac involvement of amyloid disease carries a poor prognosis and is not well characterized by classic heart failure determinants. Heart transplantation based on novel risk markers including NT-proBNP might be a suitable therapeutic approach for patients with manifest cardiac amyloidosis, but will require alternative patient selection and listing criteria.
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Affiliation(s)
- Arnt V Kristen
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Comenzo RL, Zhou P, Fleisher M, Clark B, Teruya-Feldstein J. Seeking confidence in the diagnosis of systemic AL (Ig light-chain) amyloidosis: patients can have both monoclonal gammopathies and hereditary amyloid proteins. Blood 2006; 107:3489-91. [PMID: 16439680 DOI: 10.1182/blood-2005-10-4148] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Investigators in the United Kingdom have shown that hereditary amyloidosis can be misdiagnosed as Ig light-chain (AL) amyloidosis because family history is an ineffective screen, and tissue staining used to type amyloid is unreliable. Misdiagnosis of AL can lead to inappropriate use of chemotherapy and failure to diagnose a hereditary disease. Over a 3-year period we sought to determine how often both possible sources of amyloidosis occurred in the same patient. We employed an algorithm based on established data and patterns of amyloidosis in order to focus the screening effort. Of 178 consecutive patients referred for amyloidosis, 54 were screened by polymerase chain reaction techniques with primers designed to detect transthyretin, apolipoprotein AI, apolipoprotein AII, fibrinogen Aalpha, and lysozyme variants. Three patients (6% of those screened and 2% of symptomatic patients) had both a monoclonal gammopathy and a hereditary variant. These results justify further study of screening for hereditary variants in patients with apparent AL, and highlight the need for practical techniques for identifying fibrils extracted from tissue.
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Affiliation(s)
- Raymond L Comenzo
- Howard 802, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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Abstract
Hereditary periodic fever syndromes (HPF) are a group of diseases characterised by recurrences of fever and inflammation separated by symptom-free intervals. Familial Mediterranean fever (FMF) is the most frequent entity within this group of disorders which further consists of hyperimmunoglobulinaemia D and periodic fever syndrome (HIDS), tumour necrosis factor receptor-associated periodic syndrome (TRAPS) and cryopyrin-associated periodic syndrome (CAPS). In recent years the causative genes have been identified. Reactive amyloidosis is a severe complication of HPFs. This is caused by deposition of fibrils that consist of the proteolytically cleaved acutephase protein serum amyloid A (SAA). Several factors have been identified that modulate the risk for developing amyloidosis, including SAA concentrations, polymorphisms in the SAA gene and ethnic origin. Furthermore, the risk of developing amyloidosis varies widely between the different HPFs. Colchicine is the cornerstone in the management of FMF, as it reduces the severity and frequency of attacks and is also effective in preventing amyloidosis. In the other HPFs, the introduction of anticytokine-based therapies is a promising new option in treating these inflammatory conditions and they potentially can prevent amyloidosis.
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Affiliation(s)
- J C H van der Hilst
- Division of General Internal Medicine, Department of Medicine, Radboud University Nijmegen Medical Center, 9101, 6500, HB Nijmegen, The Netherlands.
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Singer R, Mehrabi A, Schemmer P, Kashfi A, Hegenbart U, Goldschmidt H, Schönland S, Kristen A, Dengler T, Müller-Schilling M, Sauer P, Dogan A, Hund E, Helmke B, Schnabel P, Altland K, Linke R, Friess H, Schmidt J, Büchler MW, Kraus TW. Indications for Liver Transplantation in Patients with Amyloidosis: A Single-Center Experience with 11 Cases. Transplantation 2005; 80:S156-9. [PMID: 16286896 DOI: 10.1097/01.tp.0000186910.09213.bf] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Familial amyloidotic polyneuropathy (FAP) is an inherited disorder with the systemic deposition of amyloid fibrils containing mutant transthyretin variants. The mutant form of transthyretin amyloidosis is produced mainly in the liver. Successful liver transplantation (LTx) could eliminate the source of the variant transthyretin molecule, and is now the only known curative treatment. The aim of this study is to evaluate the results of LTx for FAP at the University of Heidelberg. Eleven patients who underwent LTx between 1985 and 2004 with the diagnosis of FAP were evaluated. Of 11 patients, seven (64%) were male and four (36%) were female. The mean age was 49.5 years (range 27-70). Met 30 (n=5) was the most common type of amyloidosis followed by Arg 50 (n=3), Val 107 (n=2), and Phe 33 (n=1). All of the patients were selected for LTx and Domino LTx was performed in six patients. The majority (80%) of the patients with type Met 30 amyloidosis are alive, whereas in other types of amyloidosis only 33% are living. This finding emphasizes better prognosis of Met 30 variant of FAP in comparison to other variants such as Arg 50, Val 107, and Phe 33. After LTx, improvement of clinical symptoms (completely or partially) was observed in six patients (55%). In conclusion, LTx is considered as the only therapeutic alternative in patients with amyloidosis accompanied by hepatic synthesis of the amyloid protein. The most important risk factors for LTx can be predicted by assessing the nutritional condition of the patient, the duration of the disease, and the amyloid variant. Therefore, precise diagnostic measures are required before listing a patient for LTx. Domino LTx is an acceptable form of LTx that can preserve the pool of organ donors. In order to stop the progression of FAP, LTx would be justified in a subgroup of patients with amyloidosis. Based on our results, we support the idea that the effectiveness of extended preoperative period before LTx or the transplantation of other transthyretin variants other than Met 30 is questionable.
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Affiliation(s)
- Reinhard Singer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Launay D, Copin MC, Hachulla E, Lambert M, Quémeneur T, Morell S, Queyrel V, Devulder B, Hatron PY. [Cloned amyloidosis]. Rev Med Interne 2005; 26 Suppl 2:S294-5. [PMID: 16129180 DOI: 10.1016/s0248-8663(05)81290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Launay
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, France
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