February 23, 2021
Diagnose This (February 22, 2021)
- Published: February 23, 2021
- By: Joel Murphy, MD
What is your leading diagnosis when seeing this finding along the glomerular capillary loops?
Answer: The light microscopic image of a Jones silver stain shows a glomerulus with demonstrates numerous elongated, fine spicules which some regard as the “eyelash sign”. This finding is classically seen with amyloidosis. Other glomeruli, in this case, demonstrated areas of PAS-weak to negative staining of mesangial areas which is another feature that should raise suspicion for possible amyloidosis. By electron microscopy, this case demonstrated numerous, randomly arranged fibrils that measured ~10 nm characteristic of amyloid fibrils within mesangial areas with extension into numerous capillary loops. Congo red stain was positive in glomeruli.