1
|
Xue N, Kuang W, Zhang X, Ruan M, Wang J, Zeng X. Amyloidosis initially only manifesting as oral mucosal hemorrhagic lesions: a case series report. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e133-e138. [PMID: 37648556 DOI: 10.1016/j.oooo.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 09/01/2023]
Abstract
Amyloidosis is a heterogeneous series of diseases associated with extracellular amyloid protein depositions, which can involve multiple organs and tissues, leading to tissue structure alterations and organ dysfunction. The tongue is the most frequently involved site of oral amyloidosis, and one of its characteristic clinical presentations is macroglossia. Here, we report 3 extremely rare cases of amyloidosis exclusively appearing as multiple blood blisters, petechiae, and ecchymoses of the oral mucosa, in the absence of common clinical manifestations of oral and systemic amyloidosis. In a word, we highlight the possibility of oral mucosal hemorrhagic lesions as the initial clinical signs of systemic amyloidosis and the significance of the early and timely diagnosis of amyloidosis.
Collapse
Affiliation(s)
- Ningning Xue
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wenjing Kuang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiaoling Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Minhui Ruan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Zeng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| |
Collapse
|
2
|
Abstract
Non-neoplastic skin lesions comprise a sizable group of disorders with variable etiologies and clinical manifestations. They can be grouped into vesiculopustular dermatitides; spongiotic and psoriasiform diseases; lichenoid dermatitides; lymphoid infiltrates of the dermis; granulomatous processes; bullous disorders; vasculopathies; panniculitides; deposition disorders; and defects in maintenance of dermal connective tissue. The use of histochemical methods continues to be an indispensable adjunct to conventional microscopy in the further characterization of such lesions. This review considers that topic.
Collapse
Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology & Cytopathology, University of Virginia Medical Center, 1215 Lee Street, Charlottesville, VA 22908-0214, USA.
| | | |
Collapse
|
3
|
McCormick RS, Sloan P, Farr D, Carrozzo M. Oral purpura as the first manifestation of primary systemic amyloidosis. Br J Oral Maxillofac Surg 2016; 54:697-9. [DOI: 10.1016/j.bjoms.2015.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 11/23/2015] [Indexed: 11/27/2022]
|
4
|
Ahmad QM, Sultan SJ, Shah IH, Sameem F. Systemic amyloidosis presenting as mucocutaneous bullous lesions. Hematol Oncol Stem Cell Ther 2010; 2:418-21. [PMID: 20139056 DOI: 10.1016/s1658-3876(09)50011-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 65-year-old male presented with hemorrhagic bullous skin lesions with purpura and ecchymoses. There was increased skin fragility with a strongly positive Nikolsky sign. Histopathology of the skin revealed large amounts of amyloid deposits in the dermis with a positive Congo Red staining around the dermal vessels. Examination and tests in this patient also revealed anemia, hepatomegaly, infiltrative cardiomyopathy, polyneuropathy and immunoglobulin l deposition, favoring a diagnosis of primary amyloidosis (AL type). The present case is reported in view of the rarity of the bullous variant of primary systemic amyloidosis as well as presence of mucosal lesions and a positive Nikolsky sign.
Collapse
Affiliation(s)
- Qazi M Ahmad
- Government Medical College, Srinagar, Jammu and Kashmir, India
| | | | | | | |
Collapse
|
5
|
Abstract
Amyloid and amyloidosis describes a heterogeneous group of diseases which are characterized by the pathological extracellular deposition of autologous proteins. Basically, amyloidoses can be divided into systemic or organ-limited (e.g. cutaneous) forms and can be acquired or hereditary in nature. The subclassification discriminates between primary amyloidosis (in the absence of an obvious predisposing disease) and secondary amyloidosis (if caused by a certain underlying disease). The subclassification of amyloidoses is based on the main protein constituent and therefore on the chemical composition of the amyloid fibrils. However, the exact etiopathogenesis of amyloid formation remains unclear. In addition to the clinical presentation, histology, electron microscopy and biochemical-immunological differentiation are also decisive for a proper diagnosis. In cutaneous amyloidosis the deposition of amyloid either occurs along reticulin fibers and the basal membrane (perireticulary amyloidoses) or along collagen fibers (pericollagenous amyloidosis). The purpose of this article is to provide an up-to-date overview on the different kinds of cutaneous amyloidoses.
Collapse
|
6
|
Reguiaï Z, Aïnine K, Rémy-Leroux V, Perceau G, Derancourt C, Bernard P. [Bullous amyloïdis revealing a light chains lambda myeloma]. Rev Med Interne 2006; 27:694-8. [PMID: 16930779 DOI: 10.1016/j.revmed.2006.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 05/19/2006] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Although rare, skin lesions are regularly reported in patients with systemic amyloidosis. The existence of bullous skin lesions however is very rare; only thirty cases have been previously reported. We report a new case of bullous amyloidosis revealing a light chains lambda myeloma, and underline the usual characteristics of this type of systemic amyloidosis. EXEGESIS An 85-year-old man was hospitalised for a bullous eruption associated with a general asthenia. Bullous amyloidosis revealing a light chains lambda myeloma was diagnosed and confirmed by histopathological examination of a skin biopsy specimen. The patient died of a severe congestive heart failure, 15 days later, due to cardiac involvement of the amyloidosis. CONCLUSION Bullous amyloidosis lesions can be an early manifestation of occult dysglobulinemia. Early diagnosis would allow rapid treatment, before onset of systemic amyloidosis, which is often lethal.
Collapse
Affiliation(s)
- Z Reguiaï
- Service de Dermatologie, Hôpital Robert-Debré, CHU de Reims, 51092 Reims, France.
| | | | | | | | | | | |
Collapse
|
7
|
Stoopler ET, Alawi F, Laudenbach JM, Sollecito TP. Bullous amyloidosis of the oral cavity: A rare clinical presentation and review. ACTA ACUST UNITED AC 2006; 101:734-40. [PMID: 16731392 DOI: 10.1016/j.tripleo.2006.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 12/23/2005] [Accepted: 01/02/2006] [Indexed: 11/29/2022]
Abstract
Bullous amyloidosis (BA) is a rare cutaneous manifestation primarily of systemic amyloidosis, a disease in which abnormal proteinaceous material is formed and deposited in response to inflammatory conditions and plasma cell dyscrasias. Hemorrhagic bullae indicative of BA are usually associated with purpura and may be the initial clinical signs of systemic amyloidosis or monoclonal gammopathies, such as multiple myeloma and Waldenstrom's macroglobulinemia. Bullous amyloidosis of the oral cavity is highly uncommon and can mimic other vesiculobullous lesions of the oral mucosa. This article highlights an unusual case of oral BA and reviews important aspects of the disease.
Collapse
Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | | | | | | |
Collapse
|
8
|
Rekhtman N, Hash KS, Moresi JM. Mucocutaneous bullous amyloidosis with an unusual mixed protein composition of amyloid deposits. Br J Dermatol 2005; 154:751-4. [PMID: 16536823 DOI: 10.1111/j.1365-2133.2005.07063.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a case of fatal systemic amyloidosis presenting with mucocutaneous bullous lesions in a patient with IgA kappa monoclonal gammopathy. The amyloid plaques were composed of an unusual mixture of immunoglobulin kappa light chain and amyloid A proteins. Whereas oesophageal and oropharyngeal blisters are known to occur in several types of bullous dermatoses, to our knowledge this is the first report of oesophagopharyngeal blisters complicating bullous amyloidosis.
Collapse
Affiliation(s)
- N Rekhtman
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
9
|
Giuliani M, Favia GF, Lajolo C, Miani CM. Angina bullosa haemorrhagica: presentation of eight new cases and a review of the literature. Oral Dis 2002; 8:54-8. [PMID: 11936457 DOI: 10.1034/j.1601-0825.2002.1c749.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Angina bullosa haemorrhagica (ABH) describes the acute and sometimes painful onset of oral blood-filled vesicles and bullae not attributable to blood dyscrasia, vesiculo-bullous disorders, systemic diseases or other known causes. The haemorrhagic bullae spontaneously burst after a short time resulting in ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Although the pathogenesis is still unclear, ABH seems to be a multifactorial phenomenon: dental or functional trauma seems to be the major provoking factor. The lesions of ABH can be easily confused with other mucosal diseases. It is important that the presentation of this benign disorder is distinguished from other more serious disorders with similar presenting features. The aim of this paper is to report the clinical features of eight cases of ABH, in an attempt to distinguish ABH from other blistering diseases of oral mucosa and to describe their management.
Collapse
Affiliation(s)
- M Giuliani
- School of Dentistry, Catholic University of Rome, Italy.
| | | | | | | |
Collapse
|
10
|
|
11
|
Mann JF, Zeier M, Zilow E, Schärer K, Anton-Lamprecht I, Waldherr R, Andrassy K, Ritz E. The spectrum of renal involvement in epidermolysis bullosa dystrophica hereditaria: report of two cases. Am J Kidney Dis 1988; 11:437-41. [PMID: 3369444 DOI: 10.1016/s0272-6386(88)80059-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Epidermolysis bullosa dystrophica Hallopeau-Siemens (EBDH) is one of the most severe inherited epidermolyses, a group of mechanobullous dermatological disorders. We observed two patients presenting with a severely multilating type of EBDH who developed biopsy-proven renal disease, which substantially altered the evolution and pathogenesis of their disease. In a boy, chronic postinfectious glomerulonephritis developed, most probably due to recurring superinfections of bullous skin lesions. He also experienced acute oliguric renal failure due to severe diarrhea during exacerbation of EBDH. A female patient developed a nephrotic syndrome due to secondary amyloidosis. Hypoalbuminemia caused further fluid losses through bullous skin lesions, aggravating intravascular hypovolemia and leading to rapid renal failure secondary to bilateral renal vein thrombosis. The study shows that, although rare, renal complications may alter the natural course of EBDH.
Collapse
Affiliation(s)
- J F Mann
- Department of Internal Medicine, University of Heidelberg, West Germany
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Cutaneous lesions are present in up to 40% of patients with primary and myeloma-associated systemic amyloidosis and occur as a result of tissue deposition of immunoglobulin light chain material derived from a circulating paraprotein. The occurrence of waxy, purpuric mucocutaneous lesions provides a crucial early pointer to underlying occult plasma cell dyscrasia; the combination of the symptoms of the carpal tunnel syndrome, macroglossia, and specific mucocutaneous lesions is highly characteristic. Although secondary systemic (reactive) amyloidosis rarely gives rise to clinically evident cutaneous lesions, it may be etiologically related to a number of chronic dermatoses. Lesions of nodular primary localized cutaneous amyloidosis are indistinguishable from those of primary and myeloma-associated systemic amyloidosis, and they result from local plasma cell infiltration. Macular and papular (lichen amyloidosus) variants of primary localized cutaneous amyloidosis may have a familial or racial basis and are characterized by a tendency for keratinocytes to undergo filamentous degeneration and apoptosis. The prognosis of patients with plasma cell dyscrasia-related systemic amyloidosis remains poor, since there is little response to therapy with cytotoxic agents, colchicine, or dimethylsulfoxide. Colchicine is the drug of choice in the prevention and treatment of the renal amyloidosis associated with familial Mediterranean fever, and dimethylsulfoxide may be useful in the management of patients with secondary systemic amyloidosis. Macular amyloid and lichen amyloidosus generally follow a chronic course with intractable pruritus; there have been isolated reports of the beneficial effect of dermabrasion, topical dimethylsulfoxide, and therapy with the aromatic retinoid, etretinate.
Collapse
Affiliation(s)
- S M Breathnach
- Department of Medicine (Dermatology), Charing Cross and Westminster Medical School, London, U.K
| |
Collapse
|
13
|
Huaux JP, Vandenbroucke JM, Noël H. Amyloidosis 1970-1985 with special reference to amyloid arthropathy. A discussion about 106 cases. Acta Clin Belg 1987; 42:365-80. [PMID: 3321813 DOI: 10.1080/22953337.1987.11719250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
14
|
Jensen JL, Correll RW, DeBoom GW. Recurrent petechial hemorrhages and hemorrhagic vesicles of the oral mucosa. J Am Dent Assoc 1985; 111:305-7. [PMID: 3876362 DOI: 10.14219/jada.archive.1985.0087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The foregoing case is an example of amyloidosis in which biopsy of a hemorrhagic vesicle on the buccal mucosa established the diagnosis. Once the diagnosis was made, the patient's cardiomyopathy, nephrotic syndrome, hepatomegaly, GI hemorrhage, hematuria, and oral lesions readily were explained.
Collapse
|
15
|
Abstract
A patient with a 12-year history of a relapsing bullous dermatosis is presented. Unusual clinical features included urticarial erythema, conspicuous mottled hyper- and depigmentation, lichenification and ichthyosiform hyperkeratosis. Serum immunoglobulin E levels were elevated. Histological examination showing deposits of amyloid in the uppermost dermis confirmed the diagnosis of bullous amyloidosis. Ultrastructurally, blister formation occurred at the level of the lamina lucida. The amyloid did not react with a panel of antibodies directed against amyloid fibril proteins. No underlying systemic disease was found. The bullous eruption responded to prednisolone therapy.
Collapse
|
16
|
|
17
|
|
18
|
Abstract
The variety of cutaneous lesions in primary systemic or multiple myeloma-associated amyloidosis is impressive and includes purpura, waxy papules, tumors, plaques, alopecia, and, rarely, bullae. We report a patient in whom the diagnoses of amyloidosis and multiple myeloma were established after he presented with bullae and extensive infiltrated, purpuric plaques. Immunoelectrophoresis of the blister fluid revealed an IgA kappa monoclonal protein similar to that found in the patient's serum and urine.
Collapse
|
19
|
Breathnach SM, Black MM. Systemic amyloidosis and the skin: a review with special emphasis on clinical features and therapy. Clin Exp Dermatol 1979; 4:517-36. [PMID: 394889 DOI: 10.1111/j.1365-2230.1979.tb01650.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
20
|
|