Clinical History:
The patient has numerous complaints including weakness, myalgia, arthralgia, back pain radiating down bilateral legs, cramps and twitching, imbalance, speech disorder, difficulty walking, and numbness. His past medical history is remarkable for gout and he is taking both allopurinol and colchicine. His physical exam is remarkable for mild weakness of the tibialis and gastrognemius, decreased sensation in a stocking distribution and a foot-drop on gait testing. Electrophysiological testing reveals axonal sensorimotor neuropathy with some demyelinated features. Lab testing shows CK of 322, hemoglobin A1c of 5.5, and is negative for ANA, ANCA and MPO antibodies.
What is the lightly basophilic material shown in the figures below?
Answer:
Amyloidosis
Potenital molecules: Amyloid A, immunoglobulins including light chains, Transthyretin (ATTR), Cystatin C, APOA1, gelsolin, fibrinogen, and lysozyme, among others.
Amyloid identification requires specialized testing which can include immunohistochemistry, electron microscopy and/or mass spectroscopy.
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