Transient Periorbital Amyloidosis

Clinical Image

Ann Hematol Oncol. 2020; 7(4): 1298.

Transient Periorbital Amyloidosis

Feldman SR1*, Gosch M2 and De Souza B3

¹Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, United States

²Department of Dermatology, Hospital del Salvador, Chile

³Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, United States

*Corresponding author: Steven R. Feldman, MD, Department of Dermatology, Wake Forest School of Medicine, 4618 Country Club Road, Winston-Salem, North Carolina 27104, United States

Received: April 25, 2020; Accepted: June 02, 2020; Published: June 09, 2020

Keywords

Amyloidosis; Periorbital amyloidosis; AL amyloidosis

Clinical Image

A 55-year-old man with a longstanding history of psoriasis using methotrexate, presented to the Dermatology unit. He was switched to ustekinumab for the past four years, with significant improvement. While on ustekinumab, he developed periorbital purpura of the eyelids (Figure 1). Without any history of trauma, amyloidosis was suspected. Urine and serum protein electrophoresis revealed an IgA lambda monoclonal gammopathy. His oncologist discontinued the ustekinumab and resumed methotrexate 17.5 mg weekly. After 12 weeks, lesions gradually disappear. To date, periorbital purpura resolved.

Figure 1: Patient shows bilateral Periorbital purpura, representing a localized type of AL Amyloidosis.

    

    
    

    

    Figure 1: Patient shows bilateral Periorbital purpura, representing a localized
type of AL Amyloidosis.

Systemic light chain Amyloidosis (AL) is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin are deposited in tissues. Iatrogenic amyloidosis is a rare condition; there are reports after the use of insulin and viral protein mimetics [1,2]. However, there are no reported cases of iatrogenic amyloidosis associated with the use of ustekinumab. It is still unclear whether AL developed in response to ustekinumab or discontinuing methotrexate.

References

  1. Martins CO, Lezcano C, Yi SS, Landau HJ, Chapman JR, Dogan A. Novel iatrogenic amyloidosis caused by peptide drug liraglutide: a clinical mimic of AL amyloidosis. Haematologica. 2018; 103: e610-e612.
  2. D’Souza A, Theis JD, Vrana JA, Dogan A. Pharmaceutical amyloidosis associated with subcutaneous insulin and enfuvirtide administration. Amyloid. 2014; 21: 71–75.

Citation: Feldman SR, Gosch M and De Souza B. Transient Periorbital Amyloidosis. Ann Hematol Oncol. 2020; 7(4): 1298.