A rare case of Liraglutide-induced iatrogenic amyloidosis

Abstract

Abstract Iatrogenic amyloidosis has been linked to injectable drugs such as Enfuvirtide and insulin, which can cause cutaneous deposition of insoluble proteins. We present a rare case in which Liraglutide injections resulted in an iatrogenic amyloidosis. Our patient is a 63 year-old female with a 12-year history of type 2 diabetes mellitus complicated by peripheral neuropathy, on Liraglutide for 10 years, who presented with a 4-month history of developing abdominal subcutaneous masses. She underwent abdominal soft tissue mass excision and biopsy, which revealed Congo red stain positive for amyloid and apple green birefringence on polarization. Lab work and skeletal survey showed no abnormalities. Serum protein electrophoresis revealed no monoclonal protein. Mass spectrometry of amyloid tissue at Mayo clinic revealed Liraglutide detection by immunohistochemistry using glucagon antibodies, dense amyloid deposits typical of amyloid caused by injectable drugs, and a peptide profile inconclusive for an amyloid type-all confirming a diagnosis of iatrogenic amyloidosis caused by Liraglutide injection. This case highlights a very rare side effect of Liraglutide injections. If biopsy confirms amyloid deposits, further workup is absolutely necessary to differentiate the forms of amyloidosis, as the treatment varies based on the kind of amyloidosis. Diabetic patients who are on Liraglutide can have other signs and symptoms which overlap with symptoms of AL amyloidosis. Hence further workup including mass spectroscopy to type the amyloid are vital.