Abstract
A 60-year-old woman with a 13-year history of monoclonal gammopathy of unknown significance (MGUS) presented with worsening nail dystrophy. Prior workup for systemic amyloidosis had been unrevealing, and no other signs of cutaneous disease were present. Nail biopsy was consistent with amyloid deposition, and the patient subsequently underwent autologous hematopoietic stem cell transplantation for AL amyloidosis. In light of the growing literature regarding nail changes as a presenting sign of systemic amyloidosis and the promising utility of nail biopsy, we suggest a low threshold for biopsy in appropriate patients when nail changes characteristic of amyloidosis are refractory to conventional treatment.
Highlights
CASE REPORTAmyloidosis is characterized by the extracellular deposition of insoluble fibrillary proteins
We present a case in which dystrophic nail changes were the sole presenting sign of AL amyloidosis
The patient was diagnosed with AL amyloidosis and underwent autologous hematopoietic stem cell transplantation within three months of her nail biopsy
Summary
CC Briscoe MDa, ZP Nahmias MDb, HA Jones MDb, IS Rosman MDb,c, MJ Anadkat MDb aWashington University School of Medicine bDivision of Dermatology, Washington University School of Medicine cDepartment of Pathology and Immunology, Washington University School of Medicine
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