Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis

Shyue Luen Chang, Ping Chin Lai, Chien Jui Cheng, Li Cheng Yang, Hong Shang Hong

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

We report a 78-year-old woman on hemodialysis who presented with refractory multiple pruritic vesicles and bullae on her trunk and extremities for 2 months. Histopathologic examination of skin biopsy specimen showed subepidermal bullae with many amyloid deposits in the papillary dermis. No evidence of systemic amyloidosis could be found on physical examination. While the initial clinical diagnosis was bullous pemphigoid, the histopathology and direct immunofluorescence result favored hemodialysis-associated amyloidosis. However, immunochemical study for β2-microglobulin was negative. Further hematologic and immunologic work-up revealed the presence of multiple myeloma and that the deposit was AL amyloid. This is the first case of bullous amyloidosis in a hemodialysis patient and should remind dermatologists that bullous amyloidosis should be considered in addition to the usual presentation of porphyria cutanea tarda and pseudoporphyria for bullous dermatosis in the hemodialysis patient. We also suggest that hemodialysis-associated amyloidosis should not be taken for granted in the hemodialysis patient with cutaneous amyloidosis without systemic signs and symptoms. Further testing for other types of amyloid should be performed.

Original languageEnglish
Pages (from-to)153-156
Number of pages4
JournalAmyloid
Volume14
Issue number2
DOIs
Publication statusPublished - 2007

Fingerprint

Amyloidosis
Renal Dialysis
Blister
Amyloid
Vesiculobullous Skin Diseases
Porphyria Cutanea Tarda
Bullous Pemphigoid
Direct Fluorescent Antibody Technique
Skin
Amyloid Plaques
Dermis
Multiple Myeloma
Signs and Symptoms
Physical Examination
Extremities
Biopsy

Keywords

  • Beta(β)2-microglobulin
  • Bullous amyloidosis
  • Bullous dermatosis
  • Hemodialysis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medicine(all)

Cite this

Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis. / Chang, Shyue Luen; Lai, Ping Chin; Cheng, Chien Jui; Yang, Li Cheng; Hong, Hong Shang.

In: Amyloid, Vol. 14, No. 2, 2007, p. 153-156.

Research output: Contribution to journalArticle

Chang, Shyue Luen ; Lai, Ping Chin ; Cheng, Chien Jui ; Yang, Li Cheng ; Hong, Hong Shang. / Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis. In: Amyloid. 2007 ; Vol. 14, No. 2. pp. 153-156.
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