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Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis.
Amyloid. 2007 Jun; 14(2):153-6.A

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 beta(2)-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.

Authors+Show Affiliations

Department of Dermatology, Chang-Gung Memorial Hospital, No. 199 Tunghaw N. Road, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17577689

Citation

Chang, Shyue-Luen, et al. "Bullous Amyloidosis in a Hemodialysis Patient Is Myeloma-associated Rather Than Hemodialysis-associated Amyloidosis." Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis, vol. 14, no. 2, 2007, pp. 153-6.
Chang SL, Lai PC, Cheng CJ, et al. Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis. Amyloid. 2007;14(2):153-6.
Chang, S. L., Lai, P. C., Cheng, C. J., Yang, L. C., & Hong, H. S. (2007). Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis. Amyloid : the International Journal of Experimental and Clinical Investigation : the Official Journal of the International Society of Amyloidosis, 14(2), 153-6.
Chang SL, et al. Bullous Amyloidosis in a Hemodialysis Patient Is Myeloma-associated Rather Than Hemodialysis-associated Amyloidosis. Amyloid. 2007;14(2):153-6. PubMed PMID: 17577689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis. AU - Chang,Shyue-Luen, AU - Lai,Ping-Chin, AU - Cheng,Chien-Jui, AU - Yang,Li-Cheng, AU - Hong,Hong-Shang, PY - 2007/6/20/pubmed PY - 2007/8/31/medline PY - 2007/6/20/entrez SP - 153 EP - 6 JF - Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis JO - Amyloid VL - 14 IS - 2 N2 - 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 beta(2)-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. SN - 1350-6129 UR - https://www.unboundmedicine.com/medline/citation/17577689/Bullous_amyloidosis_in_a_hemodialysis_patient_is_myeloma_associated_rather_than_hemodialysis_associated_amyloidosis_ L2 - http://www.tandfonline.com/doi/full/10.1080/13506120701259762 DB - PRIME DP - Unbound Medicine ER -