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Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis

Patient: Female, 59-year-old Final Diagnosis: Musculoskeletal amyloid Symptoms: Bilateral shoulder pain and pain in several small joints in her hands Medication: — Clinical Procedure: Laboratory tests • ultrasound of shoulders, elbows and wrists • MRI of the right shoulder joint • arthroscopic synov...

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Autores principales: Bui, Hai Binh, Phan, Thi Sinh, Truong, Quoc Thanh, Doan, Tien Luu, Van Hoang, Thi Hai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9887488/
https://www.ncbi.nlm.nih.gov/pubmed/36703525
http://dx.doi.org/10.12659/AJCR.938582
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author Bui, Hai Binh
Phan, Thi Sinh
Truong, Quoc Thanh
Doan, Tien Luu
Van Hoang, Thi Hai
author_facet Bui, Hai Binh
Phan, Thi Sinh
Truong, Quoc Thanh
Doan, Tien Luu
Van Hoang, Thi Hai
author_sort Bui, Hai Binh
collection PubMed
description Patient: Female, 59-year-old Final Diagnosis: Musculoskeletal amyloid Symptoms: Bilateral shoulder pain and pain in several small joints in her hands Medication: — Clinical Procedure: Laboratory tests • ultrasound of shoulders, elbows and wrists • MRI of the right shoulder joint • arthroscopic synovectomy and removal of the suspicious tumor of the shoulder Specialty: Rheumatology OBJECTIVE: Mistake in diagnosis BACKGROUND: Amyloid light-chain (AL) amyloidosis is usually due to deposition of immunoglobulin lambda light chains from plasma cells in patients with multiple myeloma. AL amyloid may involve the salivary glands, gastrointestinal tract, peripheral nerves, and skin. However, musculoskeletal amyloid and amyloid arthropathy are rare. This report is of a woman with bilateral upper limb musculoskeletal amyloid and amyloid arthropathy associated with multiple myeloma, initially diagnosed and managed as a case of rheumatoid arthritis. CASE REPORT: A 59-year-old woman who was initially diagnosed with rheumatoid arthritis presented with bilateral polyarthritis in the upper limbs. Despite treatment with corticosteroids, methotrexate, and hydroxychloroquine, her symptoms did not improve. After 4 months, she revisited our hospital with the appearance of swollen soft tissue in the upper right arm and numbness of the right hand. She had an arthroscopic synovectomy of the right shoulder joint, and the mass in the right elbow area was removed. These specimens were positive by Congo red stain and confirmed the deposition of light chain protein as amyloid. She was diagnosed with multiple myeloma according to International Myeloma Working Group criteria, including bone marrow plasma cells more the 10%, lytic lesions in bone, and anemia. CONCLUSIONS: This report highlights the importance of imaging, biopsy, and laboratory investigations in patients with arthropathy and musculoskeletal disease. In this case, the patient was seronegative for rheumatoid arthritis, and the presentation with very thick and nodular synovium supported an alternative diagnosis. The identification of musculoskeletal amyloid and amyloid arthropathy confirmed underlying multiple myeloma.
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spelling pubmed-98874882023-02-07 Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis Bui, Hai Binh Phan, Thi Sinh Truong, Quoc Thanh Doan, Tien Luu Van Hoang, Thi Hai Am J Case Rep Articles Patient: Female, 59-year-old Final Diagnosis: Musculoskeletal amyloid Symptoms: Bilateral shoulder pain and pain in several small joints in her hands Medication: — Clinical Procedure: Laboratory tests • ultrasound of shoulders, elbows and wrists • MRI of the right shoulder joint • arthroscopic synovectomy and removal of the suspicious tumor of the shoulder Specialty: Rheumatology OBJECTIVE: Mistake in diagnosis BACKGROUND: Amyloid light-chain (AL) amyloidosis is usually due to deposition of immunoglobulin lambda light chains from plasma cells in patients with multiple myeloma. AL amyloid may involve the salivary glands, gastrointestinal tract, peripheral nerves, and skin. However, musculoskeletal amyloid and amyloid arthropathy are rare. This report is of a woman with bilateral upper limb musculoskeletal amyloid and amyloid arthropathy associated with multiple myeloma, initially diagnosed and managed as a case of rheumatoid arthritis. CASE REPORT: A 59-year-old woman who was initially diagnosed with rheumatoid arthritis presented with bilateral polyarthritis in the upper limbs. Despite treatment with corticosteroids, methotrexate, and hydroxychloroquine, her symptoms did not improve. After 4 months, she revisited our hospital with the appearance of swollen soft tissue in the upper right arm and numbness of the right hand. She had an arthroscopic synovectomy of the right shoulder joint, and the mass in the right elbow area was removed. These specimens were positive by Congo red stain and confirmed the deposition of light chain protein as amyloid. She was diagnosed with multiple myeloma according to International Myeloma Working Group criteria, including bone marrow plasma cells more the 10%, lytic lesions in bone, and anemia. CONCLUSIONS: This report highlights the importance of imaging, biopsy, and laboratory investigations in patients with arthropathy and musculoskeletal disease. In this case, the patient was seronegative for rheumatoid arthritis, and the presentation with very thick and nodular synovium supported an alternative diagnosis. The identification of musculoskeletal amyloid and amyloid arthropathy confirmed underlying multiple myeloma. International Scientific Literature, Inc. 2023-01-27 /pmc/articles/PMC9887488/ /pubmed/36703525 http://dx.doi.org/10.12659/AJCR.938582 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Bui, Hai Binh
Phan, Thi Sinh
Truong, Quoc Thanh
Doan, Tien Luu
Van Hoang, Thi Hai
Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis
title Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis
title_full Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis
title_fullStr Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis
title_full_unstemmed Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis
title_short Case Report of 59-Year-Old Woman with Bilateral Upper Limb Musculoskeletal Amyloid, Initially Diagnosed as Rheumatoid Arthritis
title_sort case report of 59-year-old woman with bilateral upper limb musculoskeletal amyloid, initially diagnosed as rheumatoid arthritis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9887488/
https://www.ncbi.nlm.nih.gov/pubmed/36703525
http://dx.doi.org/10.12659/AJCR.938582
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