Primary amyloidosis

Indukooru Subrayalu Reddy¹ , Gowrishankar Swarnalata²

¹ Department of Dermatology, Apollo Hospitals, Jubilee Hills, Hyderabad, Andhra Pradesh, India
² Department of Pathology, Apollo Hospitals, Jubilee Hills, Hyderabad, Andhra Pradesh, India

Correspondence Address:
Indukooru Subrayalu Reddy
A 8 Anand Sheel Enclave, Nandi Nagar, Road No. 14 Banjara Hills, Hyderabad - 500 033
India

A 43-year-old woman with hypertension and chronic kidney disease on maintenance hemodialysis for 7 months developed multiple, asymptomatic, waxy papules and plaques, some of them hemorrhagic, over the eye lids, paranasal area [Figure - 1], neck, and lower abdomen since 4 months. She was admitted in the intensive medical care with altered sensorium, hypotension, gram-negative septicemia, severe anemia, and hypercalcemia. Skin biopsy of waxy papules showed atrophic epidermis and dense deposits of amyloid in the papillary dermis. Bone marrow aspiration revealed 31% plasma cells and serum protein immune electrophoresis showed a grossly elevated lambda free light chain level (1990 mg/dl). Correlating the clinical features, skin biopsy, and immune electrophoresis findings, she was diagnosed as having primary systemic amyloidosis secondary to multiple myeloma.

Figure 1: Waxy papules and plaques and hemorrhagic crusts involving both upper and lower eye lids

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