Primary Cutaneous Amyloidosis Research Articles

Nodular Pulmonary Amyloidosis with Interstitial Lung Disease—Case Report and Literature Review

Nodular Pulmonary Amyloidosis with Interstitial Lung Disease—Case Report and Literature Review

Clinical observation of cutaneous nodular amyloidosis

Clinical observation of cutaneous nodular amyloidosis

Primary Localized Cutaneous Amyloidosis in Central Europe: A Retrospective Monocentric Study on Epidemiology and Therapy.

Amyloid deposits can be the cause of many chronic diseases. Primary localized cutaneous amyloidosis (PLCA) is a chronic dermatologic condition with amyloid deposits in the papillary dermis. The most common types of the keratinocyte-derived form of PLCA include macular (MA), lichen (LA), and biphasic (BA) amyloidosis. The estimated prevalence of PLCA in the Asian population is 0.98/10,000, which is higher than in the European population; thus, epidemiologic data on PLCA in the Caucasian population are limited. We performed a retrospective single-center study analyzing epidemiologic characteristics of a Central European PLCA population. Epidemiologic data regarding age, sex, skin phototype (Fitzpatrick scale I-VI), disease duration, comorbidities, history of atopy, and family history of PLCA were collected. Clinical characteristics, localization of PLCA lesions, applied therapies and treatment outcomes were also analyzed. Dermoscopic characteristics were also evaluated. A total of 41 patients diagnosed with PLCA were included, with 22 presenting with macular, 18 with lichen, and 1 with biphasic amyloidosis. The male/female ratio was 16/25, and mean age at diagnosis was 54.6 ± 15.2 years (range 27-87 years). The mean age at the onset of PLCA was 53 ± 16.1 years (range 19-79 years) in MA, 46.7 ± 18.2 years (range 14-73 years) in LA, and 26 years in BA. The interscapular region in MA and the extensor surface of the lower extremities in LA proved to be localization-related areas. In our center, a wide range of therapeutic options was applied, with the most prescribed being topical corticosteroids in all types of PLCA. We presented a retrospective, monocentric study on the epidemiology of PLCA in the Central European region. By examining the medical data of a significant number of PLCA patients, we compared our epidemiologic data with that of the Asian PLCA population. Due to the rarity of the condition, further randomized controlled trials and guidelines are needed to improve therapeutic outcomes.

Dermatoscopy of primary localised cutaneous amyloidosis - A cross-sectional study in a setting of South Asian public dermatology department.

Amyloidosis, deposition of misfolded protein in body, is a fairly common condition. The deposition of misfolded proteins in skin which occurs in absence of systemic comorbidities, namely Primary Cutaneous Amyloidosis (PCA) is also a well-known entity in skin of colour patients of Asian subcontinent. Primary Cutaneous Amyloidosis is usually diagnosed with good clinical acumen and typical clinical phenotype and involved site. Dermoscope has been used as an adjunct non-invasive tool to confirm cases with diagnostic uncertainty and in those in whom biopsy is deferred. Typical dermoscopic features of PCA helps differentiate it from other pigmentary dermatoses and avoids unwanted invasive biopsies and investigations especially in resource poor settings with financial constraints. This study aims to identify and corroborate clinically, typical dermoscopic features in PCA in 42 patients which includes Macular Amyloidosis (MA) and Papular Amyloidosis (PA) predominantly in skin of colour patients from government based hospital of a south east Asian country. Patients with classic clinical features of PCA were selected. Primary Cutaneous Amyloidosis was subclassified into MA or PA and their corresponding clinically corroborative dermoscopic features were enlisted respectively. All patients (treatment naïve and previously treated), who consented to participate in the study were included. Patients were diagnosed based on the prototypical clinical features. Dermoscopy was done using DermLite III DL3N Polarised and Fluid Dermoscope w/PigmentBoost Brand (3Gen, DermLite LLC, San Juan Capistrano, CA, USA) and images were obtained to create digital dermoscopy system by attaching camera-equipped mobile device via an optional connection kit (Redmi Note 11, MIUI version 13.0.5, CHINA) and the findings were enlisted concurrently. In this study of dermoscopic findings of PCA, 42 patients were evaluated for their clinical lesions along with its corroboration with the dermoscopic features. Macular Amyloidosis was seen in 30 patients and 12 patients had typical cutaneous phenotypic and dermoscopic feature of PA. The most common dermoscopic finding seen in patients with MA was shiny to dull white, circular or oval central hub surrounded with halo of light brown dots. Most common configuration of brownish pigmentation around central hub was fine streak type. Also eccrine clues were seen in some cases of MA, which was a unique finding. Similarly in the PA subtype, the central hub was replaced by scar like structureless translucent white area surrounded by brownish black dot like structures, especially in those with large and thick plaques. Dermoscopic findings of PCA and their clinical corroboration is a much-needed aspect in treating patients with pigmentary disorders and in those with skin of colour, especially in developing countries. Utilization of dermoscope in clinical settings of low income countries and in government based hospitals will decrease the add on economic burden of invasive diagnostic modalities like biopsy and other inadvertent tests done to rule out pigmentary conditions.

Generalized lichen amyloidosis in a pregnant woman: Coincidence or association

A 32-year-old Thai woman in her first pregnancy presented with multiple hyperpigmented, hyperkeratotic, pruritic, discrete papules coalescing to form plaques with a rippled pattern on the extensor surfaces of upper and lower limbs, back, chest, and abdomen. Her mother had a similar history. Histopathology of the lesion revealed a diagnosis of lichen amyloidosis, confirmed by the Congo red stain. The lesions had started one year prior and had remained stable before pregnancy; however, they became widespread after pregnancy. Thus, prompting the question as to whether this was a coincidence or if the pregnancy had exacerbated the condition. In this case report, we will discuss our approach to this patient and our opinions concerning the relationship between pregnancy and lichen amyloidosis.

Characterization of Epidermal Function in Individuals with Primary Cutaneous Amyloidosis.

To compare epidermal biophysical properties, indicators of epidermal function, in individuals with and without primary cutaneous amyloidosis (PCA). This study incorporated 189 patients with PCA and 166 healthy individuals. The GPSkin Barrier was employed to measure transepidermal water loss (TEWL) rates and hydration levels of the stratum corneum. The Sebumeter and the Skin pH Meter were utilized to determine the skin surface's sebum content and pH, respectively. The severity of pruritus in participants was evaluated using the visual analog scale (VAS). Compared to the control group without PCA, individuals with PCA displayed a notable increase in skin surface pH and TEWL and a decrease in the hydration levels of the stratum corneum (p<0.0001 for all parameters). Additionally, the sebum content was markedly lower in those with PCA than in the controls (p<0.0001). Of particular note, both TEWL and skin surface pH at the lesion sites on the back and the shin were more elevated in lichenoid amyloidosis (LA) and in macular amyloidosis (MA), whereas hydration levels of the stratum corneum and sebum levels were diminished in LA compared to MA (p<0.05). In conclusion, both hydration levels of the stratum corneum and sebum content exhibited an inverse relationship with pruritus severity, whereas TEWL and skin surface pH demonstrated a positive correlation with pruritus intensity. The function of the epidermis is compromised in individuals diagnosed with PCA. However, the mechanisms underlying these changes await further investigation.

CT showed multiple pulmonary balloon lesions with intermediate balloon calcification in a case of nodular pulmonary amyloidosis: A case report.

Amyloidosis is a rare disease characterized by the misfolding of autologous proteins and extracellular deposition of fibrils, which can involve 1 or more vital organs in the body. Nodular pulmonary amyloidosis with extensive pulmonary cysts is even less common. This study discusses the diagnosis and treatment of a case of pulmonary nodular amyloidosis with extensive pulmonary cysts and calcification in the middle of the cysts on chest computed tomography, and reviews the related literature. We hope that this rare case will raise awareness of this disease among clinicians. Multiple pulmonary nodules and cysts were found on computed tomography of the chest, and the patient was eager to further clarify the nature of the nodules and the next treatment plan. Amyloidosis of pulmonary nodules. Since the patient's primary lesion was outside the bronchial lumen near the hilum, we opted for endobronchial ultrasound-guided tunnel biopsy to obtain pathological specimens, and confirmed the diagnosis of nodular pulmonary amyloidosis. After a definite diagnosis, the patient was regularly followed without any specific treatment. For patients with multiple pulmonary nodules combined with extensive pulmonary cysts, we also need to be alert to the possibility of pulmonary nodule amyloidosis. Secondly, when the main lesion is located outside the bronchial cavity near the hilum of the lung, the method of pathological tissue biopsy should also consider endobronchial ultrasound-guided tunnel biopsy.

EXPLORING MACULAR AMYLOIDOSIS IN PHOTOEXPOSED AREAS: CLINICAL AND HISTOLOGICAL INSIGHTS

Macular amyloidosis is a dermatological condition characterized by the deposition of amyloid proteins in the skin, particularly in photoexposed areas. This study offers clinical and histological insights into macular amyloidosis, focusing on its presentation, diagnosis, and histopathological features. A comprehensive review of clinical cases and histological specimens was conducted, highlighting common clinical manifestations and characteristic histological findings associated with macular amyloidosis. The study sheds light on the pathogenesis and etiology of the condition, exploring the role of chronic sun exposure and genetic predisposition. Additionally, diagnostic challenges and therapeutic options for macular amyloidosis are discussed, emphasizing the importance of accurate diagnosis and multidisciplinary management approaches.

DP25 Widespread subcutaneous nodular kappa light chain amyloidosis

Abstract A 69-year-old woman was referred to the dermatology department for evaluation of multiple widespread subcutaneous lesions involving the neck, torso and limbs. These lesions, initially diagnosed in the community as lipomas, had been slowly progressing in size and number for 3 years. She had remained systemically well. Her only medical history was essential thrombocythaemia. She took no regular medication. On examination, there were multiple subcutaneous lesions appreciated on palpation with no overlying epidermal change. The patient was experiencing pain in a sciatic distribution. Magnetic resonance imaging of the femur showed a 12-cm enhancing area of subcutaneous nodularity encasing the sciatic nerve. Computed tomography of the chest, abdomen and pelvis showed multiple subcutaneous, ill-defined, soft tissue lesions of the anterior abdominal wall with no lymphadenopathy or organ abnormality. Deep incisional biopsies from two separate locations were completed. There was an unremarkable epidermis and dermis. In the subcutaneous fat, the septae appeared thickened alongside thickened elastic fibres and a prominent multifocal granulomatous reaction with a high degree of elastophagocytosis. There were multifocal aggregates of plasma cells that displayed no cytological atypia. In situ hybridization showed strong kappa light chain restriction. Plasma protein electrophoresis was completed and confirmed a paraprotein band in the gamma region of IgM kappa. Full blood count revealed a high platelet count (585 × 109 cells L–1) but was otherwise unremarkable alongside normal renal and liver function, bone profile, lactate dehydrogenase, B2 microglobulin, Bence–Jones proteins and infection screen. A Congo red stain was performed on the original histological samples. This showed apple green birefringence under polarized light-confirming amyloid. Haematology completed a bone marrow biopsy, which was normal. Referral to the National Amyloid Centre was made. Serum amyloid P scan showed no visceral involvement. A diagnosis of subcutaneous amyloid kappa light chain subtype (AL) was made. The patient has since commenced rituximab, bortezomib (Velcade®), cyclophosphamide and dexamethasone (R-VCD) chemotherapy at 4-weekly intervals over a 4-month period. Primary localized cutaneous amyloidosis is characterized by extracellular deposition of amyloid protein in the skin without evidence of systemic involvement and is often subtyped into macular, papular and nodular. Amyloidoma (tumoral amyloidosis) is rare and defined as a solitary localized deposit of amyloid. There are only four case reports in the literature of multiple subcutaneous amyloid deposits, and only one of these cases was of AL (light chain) vs. amyloid A (AA) subtype. This case showed nodules restricted to the neck (Nguyen TU, Oghalai JS, McGregor DK et al. Subcutaneous nodular amyloidosis: a case report and review of the literature. Hum Pathol 2001; 32:346–8). To our knowledge, this is the first case of widespread kappa light chain subcutaneous amyloidosis.

PD14 Audit of urgent phototherapy referrals

Abstract The British Association of Dermatologists’ (BAD) phototherapy guidelines state that patients referred urgently for phototherapy should start treatment within 3 weeks of referral and that if the patient is considered to require treatment urgently, then it should be started as soon as possible, to reduce patient discomfort and avoid the need for hospital admission. The prepandemic waiting time for urgent referrals, according to an audit in March 2021, was 6 weeks, but this time was even longer postpandemic. During the COVID-19 pandemic lockdown, the phototherapy service was suspended and then resumed in reduced capacity in our unit. The pandemic is also likely to have affected disease severity and patient’s concerns about treatment with systemic options. Our audit objective was to identify the time taken between referral to treatment start time for urgent referrals. Secondary objectives were to identify whether there was any prevalence of certain disease categories in deciding upon urgent referrals, and to identify if severity assessment scores were checked prior to urgent referrals by referring clinicians as per local guidelines. The audit was conducted retrospectively by including all urgent phototherapy referrals for 6 months between January and June 2022. Sixty-four urgent referral forms were analysed. The time taken between referral to treatment start time was 12 months. The majority of the urgent referrals (73%) were for eczema, 16% for psoriasis and 5% for mycosis fungoides. Other conditions such as polymorphic light eruptions, lichen planus and macular amyloidosis totalled 6% of referrals. Only 26% of referrals had documented disease severity scores. Thirty per cent of the referrals were &amp;lt; 18 years of age; young adults (19–25 years) accounted for 19% of referrals. Time taken between referral to treatment start time was 12 months, which significantly exceeded BAD standards. A number of factors affected this, including the impact of the COVID-19 lockdown on services and treatment capacity, patient choices and escalation of disease severity in lockdown, increased referrals with severe skin disease, preference in certain age groups such as children, and psychosocial factors. Patients with severe skin disease needing urgent treatment should be carefully triaged to receive treatment urgently, to avoid admission. Clinicians should assess this appropriately on a case-by-case basis and document disease severity scores and impact of skin disease in all urgent referrals.

A clinical case of familial cutaneous amyloidosis

Amyloidosis is a rare metabolic disease associated with the formation of an abnormal amyloid protein and has a complex mechanism of development in which hereditary, endocrine, enzyme and immune factors are involved. There are several types of amyloid, the main of which are AL a derivative of the light chains of immunoglobulins, AA a derivative of the acute phase of protein -globulin and amyloid associated with keratin AK. Amyloidosis can be systemic, with damage to various organs and tissues and localized (local). With localized amyloidosis of the skin, amyloid AK is mainly determined, with a nodular plaque variant amyloid AK and AL. Amyloidosis of the skin mainly has a benign course, however, in 510 % of patients with a nodularplaque variant of cutaneous amyloidosis, in the future amyloid changes in internal organs are formed, therefore this variant is potentially systemic.&#x0D; A clinical case of familial cutaneous amyloidosis in a mother and a daughter is described. The disease began in the mother at the age of 58, in the daughter at 37 years old without any obvious reasons. In the mother, the cutaneous pathological process had a more pronounced character with the formation of multiple dense brownish-brown nodes in the hips and shins,1,52,0 cm in diameter, merging into large bumpy plaques with excoriations, serous-hemorrhagic crusts and small-plate peeling on the surface. In the daughter, single nodes with a diameter of 1,01,5 cm, with clear boundaries, without a tendency to merge, were observed on the back surface of the shins.&#x0D; Histological and ultrasonic examination was used to confirm the diagnosis. Despite the fact that amyloidosis is difficult to treat, a positive dynamics resulting from the therapy was noted quite quickly in both women. Given the fact that nodular plaque amyloidosis of the skin may precede the systemic amyloidosis, both women need to undergo a follow-up observation from a therapist to monitor the general condition and a timely detection and correction of internal organ damage.

Papular interstitial elastolytic giant cell granuloma concomitant with lichen amyloidosus in a type II diabetes patient

AbstractThe papular variant of elastolytic giant cell granuloma (EGCG) is a rare variant of EGCG, and it is occasionally associated with metabolic comorbidities, including diabetes mellitus (DM). Although the mechanisms of developing EGCG are still unknown, one of the possible mechanisms for ECGC developing in a DM patient might be explained by hyperglycaemia‐induced inflammation. In this report, we described a case of papular interstitial EGCG mainly composed of matrix metalloproteinase (MMP)‐9 bearing cells, concomitant with lichen amyloidosus in a type II DM patient.

Barrier function and ultrastructure characteristics of epidermis in patients with primary cutaneous amyloidosis.

Previous studies on primary cutaneous amyloidosis (PCA) have mainly focused on exploring genetic mutation and components of amyloid in patients with PCA. However, studies on skin barrier function in PCA patients are scarce. Here, we detected the skin barrier function in PCA patients and healthy people by using noninvasive techniques and characterized ultrastructural features of PCA lesions compared with healthy people using transmission electron microscopy (TEM). The expression of proteins related to skin barrier function was examined by immunohistochemistry staining. A total of 191 patients with clinically diagnosed PCA and 168 healthy individuals were enrolled in the study. Our analysis revealed that all investigated lesion areas displayed higher transepidermal water loss and pH values, and lower Sebum levels and stratum corneum hydration levels in PCA patients compared with the same site area in healthy individuals. The TEM results showed that the intercellular spaces between the basal cells were enlarged and the number of hemidesmosomes decreased in PCA lesions. Immunohistochemical staining showed that the expression of integrin α6 and E-cadherin in PCA patients was less than that in healthy controls, while no differences in the expression of loricrin and filaggrin were observed. Our study revealed that individuals with PCA displayed skin barrier dysfunction, which may be related to alterations in epidermal ultrastructure and a decrease in the skin barrier-related protein E-cadherin. However, the molecular mechanisms underlying skin barrier dysfunction in PCA remain to be elucidated.

Localized Cutaneous Nodular Amyloidosis: A Specific Cutaneous Manifestation of Sjögren's Syndrome.

Primary localized cutaneous nodular amyloidosis (PLCNA) is a rare condition attributed to plasma cell proliferation and the deposition of immunoglobulin light chains in the skin without association with systemic amyloidosis or hematological dyscrasias. It is not uncommon for patients diagnosed with PLCNA to also suffer from other auto-immune connective tissue diseases, with Sjögren's syndrome (SjS) showing the strongest association. This article provides a literature review and descriptive analysis to better understand the unique relationship between these two entities. To date, 34 patients with PLCNA and SjS have been reported in a total of 26 articles. The co-existence of PLCNA and SjS has been reported, especially in female patients in their seventh decade of life with nodular lesions on the trunk and/or lower extremities. Acral and facial localization, which is a typical localization of PLCNA in the absence of SjS, seems to be much more unusual in patients with associated SjS.

Successful treatment of lichen amyloidosis coexisting with atopic dermatitis by dupilumab: Four case reports

Lichen amyloidosis (LA) is a chronic, severely pruritic skin disease, which is the most common form of primary cutaneous amyloidosis. The treatment of LA has been considered to be difficult. LA may be associated with atopic dermatitis (AD), and in this setting, the treatment options may be more limited. Herein, we report four cases of LA associated with AD successfully treated by dupilumab. In this article, we describe four cases of patients who presented with recurrent skin rash accompanied by severe generalized intractable pruritus, diagnosed with refractory LA coexisting with chronic AD. Previous treatments had not produced any apparent improvement. Thus, we administered dupilumab injection subcutaneously at a dose of 600 mg for the first time and 300 mg every 2 wk thereafter. Their lesions all markedly improved. Dupilumab may be a new useful treatment for LA coexisting with AD.

AHNAK, regulated by the OSM/OSMR signaling, involved in the development of primary localized cutaneous amyloidosis

BackgroundPrimary localized cutaneous amyloidosis (PLCA) is a chronic skin disease characterized by aberrant keratinocyte differentiation, epidermal hyperproliferation, and amyloid deposits. Previously, we demonstrated OSMR loss-function mutants enhanced basal keratinocyte differentiation through the OSMR/STAT5/KLF7 signaling in PLCA patients. ObjectiveTo investigate the underlying mechanisms involved in basal keratinocyte proliferation in PLCA patients that remain unclear. MethodsPatients with pathologically confirmed PLCA visiting the dermatologic outpatient clinic were involved in the study. Laser capture microdissection and mass spectrometry analysis, gene-edited mice, 3D human epidermis culture, flow cytometry, western blot, qRT-PCR and RNA sequencing were used to explore the underlying molecular mechanisms. ResultsIn this study, we found that AHNAK peptide fragments were enriched in the lesions of PLCA patients, as detected by laser capture microdissection and mass spectrometry analysis. The upregulated expression of AHNAK was further confirmed using immunohistochemical staining. qRT-PCR and flow cytometry revealed that pre-treatment with OSM can inhibit AHNAK expression in HaCaT cells, NHEKs, and 3D human skin models, but OSMR knockout or OSMR mutations abolished this down-regulation trend. Similar results were obtained in wild-type and OSMR knockout mice. More importantly, EdU incorporation and FACS assays demonstrated the knockdown of AHNAK could induce G1 phase cell cycle arrest and inhibit keratinocyte proliferation. Furthermore, RNA sequencing revealed that AHNAK knockdown regulated keratinocyte differentiation. ConclusionTaken together, these data indicated that the elevated expression of AHNAK by OSMR mutations led to hyperproliferation and overdifferentiation of keratinocytes, and the discovered mechanism might provide insights into potential therapeutic targets for PLCA.

Dupilumab for treatment of severe atopic dermatitis accompanied by lichenoid amyloidosis in adults: Two case reports

Lichenoid amyloidosis (LA) is a subtype of primary cutaneous amyloidosis characterized by persistent multiple groups of hyperkeratotic papules, usually on the lower leg, back, forearm, or thigh. LA may be associated with several skin diseases, including atopic dermatitis (AD). The treatment of LA is considered to be difficult. However, as there is some overlap in the etiopathogenesis of LA and AD, AD treatment may also be effective for LA. Case 1: A 70-year-old man was diagnosed with severe AD with LA based on large dark erythema and papules on the trunk and buttocks and dense hemispherical millet-shaped papules with pruritus on the extensor side of the lower limbs. He had a long history of the disease (8 years), with repeated and polymorphic skin lesions. Given the poor efficacy of traditional treatments, this patient was recommended to receive dupilumab treatment. At the initial stage, 300 mg was injected subcutaneously every 2 wk. After 28 wk, the drug interval was extended to 1 mo due to the pandemic. Follow-up observations revealed that the patient reached an Eczema Area Severity Index of 90 (skin lesions improved by 90% compared with the baseline) by the end of the study. Moreover, Investigator's Global Assessment score was 1, and scoring atopic dermatitis index and numeric rating scale improved by 97.7% and 87.5% compared with the baseline, respectively, with LA skin lesions having largely subsided. Case 2: A 30-year-old woman was diagnosed with severe AD with LA, due to dense and substantial papules on the dorsal hands similar to changes in cutaneous amyloidosis, and erythema and papules scattered on limbs and trunk with pruritus, present for 25 years. After 16 wk of dupilumab treatment, she stopped, and skin lesions completely subsided, without recurrence since the last follow-up. Dupilumab shows rational efficacy and safety in the treatment of severe AD with LA, in addition to benefits in the quality of life of the patients.

Post-Mortem Diagnosis of a Rare Case of Massive Nodular Pulmonary Amyloidosis in a Forensic Setting.

Post-Mortem Diagnosis of a Rare Case of Massive Nodular Pulmonary Amyloidosis in a Forensic Setting.

Primary cutaneous amyloidosis: A review of the available studies and gaps in data.

Australasian Journal of DermatologyEarly View REVIEW ARTICLE Primary cutaneous amyloidosis: A review of the available studies and gaps in data Tim Aung FRACGP, FRNZCGP, Dip in Gen Derm and Skin Cancer Surgery, Certificate in Dermatoscope, Corresponding Author Tim Aung FRACGP, FRNZCGP, Dip in Gen Derm and Skin Cancer Surgery, Certificate in Dermatoscope [email protected] orcid.org/0000-0001-9067-2203 General Practice, Brisbane, Queensland, Australia Correspondence Tim Aung, C/- Star Medical Centre-Woodridge, 29 Station Rd, Logan Central, Qld 4114, Australia. Email: [email protected]Search for more papers by this authorRowland Noakes FACD, Rowland Noakes FACD orcid.org/0000-0001-9908-3325 Queensland Institute of Dermatology, South Brisbane, Queensland, AustraliaSearch for more papers by this authorDedee F. Murrell MA (Cambridge) BMBCh (Oxford) FAAD (USA) MD (UNSW) FACD, FRCP (Edin) DSc (Oxford), Dedee F. Murrell MA (Cambridge) BMBCh (Oxford) FAAD (USA) MD (UNSW) FACD, FRCP (Edin) DSc (Oxford) orcid.org/0000-0003-2971-0199 Faculty of Medicine, UNSW Medical School, Sydney, New South Wales, Australia Department of Dermatology, St George Hospital Campus, Kogarah, Sydney, New South Wales, Australia The George Institute for Global Health, Sydney, New South Wales, AustraliaSearch for more papers by this authorBenjamin S. Daniel MMed (Clin Epi), FACD, Benjamin S. Daniel MMed (Clin Epi), FACD orcid.org/0000-0002-2675-1115 Department of Dermatology, St Vincent's Hospital- Melbourne, St George Hospital- Sydney, University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorAwatef Kelati MD, Awatef Kelati MD orcid.org/0000-0003-2570-4584 Department of Dermatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MoroccoSearch for more papers by this author Tim Aung FRACGP, FRNZCGP, Dip in Gen Derm and Skin Cancer Surgery, Certificate in Dermatoscope, Corresponding Author Tim Aung FRACGP, FRNZCGP, Dip in Gen Derm and Skin Cancer Surgery, Certificate in Dermatoscope [email protected] orcid.org/0000-0001-9067-2203 General Practice, Brisbane, Queensland, Australia Correspondence Tim Aung, C/- Star Medical Centre-Woodridge, 29 Station Rd, Logan Central, Qld 4114, Australia. Email: [email protected]Search for more papers by this authorRowland Noakes FACD, Rowland Noakes FACD orcid.org/0000-0001-9908-3325 Queensland Institute of Dermatology, South Brisbane, Queensland, AustraliaSearch for more papers by this authorDedee F. Murrell MA (Cambridge) BMBCh (Oxford) FAAD (USA) MD (UNSW) FACD, FRCP (Edin) DSc (Oxford), Dedee F. Murrell MA (Cambridge) BMBCh (Oxford) FAAD (USA) MD (UNSW) FACD, FRCP (Edin) DSc (Oxford) orcid.org/0000-0003-2971-0199 Faculty of Medicine, UNSW Medical School, Sydney, New South Wales, Australia Department of Dermatology, St George Hospital Campus, Kogarah, Sydney, New South Wales, Australia The George Institute for Global Health, Sydney, New South Wales, AustraliaSearch for more papers by this authorBenjamin S. Daniel MMed (Clin Epi), FACD, Benjamin S. Daniel MMed (Clin Epi), FACD orcid.org/0000-0002-2675-1115 Department of Dermatology, St Vincent's Hospital- Melbourne, St George Hospital- Sydney, University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorAwatef Kelati MD, Awatef Kelati MD orcid.org/0000-0003-2570-4584 Department of Dermatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MoroccoSearch for more papers by this author First published: 24 February 2023 https://doi.org/10.1111/ajd.14012Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Pulmonary multinodular amyloidosis: A case report

Nodular pulmonary amyloidosis is rare in our environment with a low incidence. A 77 year old female patient, who began her illness 20 days before hospital admission with sporadic non productive cough without attack to the general condition