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AL amyloidosis presenting as inflammatory polyarthritis: a case report
Muhammad Shoaib Momen Majumder1, Shamim Ahmed1, Md Nahiduzzamane Shazzad1
1Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Modern Rheumatology Case Reports
|December 3, 2020
Summary
Amyloidosis, a rare condition, can mimic rheumatic diseases with symptoms like joint pain and stiffness. Early diagnosis of AL amyloidosis is crucial for better treatment outcomes.
Area of Science:
- Rheumatology
- Nephrology
- Hematology
Background:
- Amyloidosis involves extracellular fibril deposition, commonly affecting organs like kidneys and heart.
- Synovial deposition of amyloid fibrils is rare, often presenting with subtle musculoskeletal symptoms.
- Rheumatic disease mimicry by amyloidosis can lead to diagnostic delays.
Observation:
- A 55-year-old man presented with inflammatory polyarthritis, morning stiffness, low back pain, and macroglossia.
- Clinical findings included anemia, characteristic skin lesions, bilateral carpal tunnel syndrome, and joint swelling with contractures.
- Standard rheumatic disease markers (RF, ACPA) were negative, and sacroiliac X-rays were normal.
Findings:
- Skin biopsy confirmed amyloidosis.
- Serum free light chain (FLC) assay and plasma immunoelectrophoresis revealed lambda light chain monoclonal gammopathy.
- Absence of Bence Jones protein and normal bone marrow studies ruled out other conditions.
Implications:
- AL amyloidosis should be considered in patients with atypical rheumatic symptoms.
- A high index of suspicion is necessary for timely diagnosis.
- Delayed diagnosis of amyloidosis negatively impacts treatment outcomes.
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