PMC6499096_01
Skin examination revealing confluent inflammatory nodules with purulent spontaneous drainage (Hurley 3/3) in the gluteal and axillar regions
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Examination of the skin revealed confluent inflammatory nodules with purulent drainage (Hurley 3/3) in the gluteal area (Fig. 1).
Renal biopsy with Congo-Red stain revealing orange-red deposits in all 34 glomeruli and vascular walls
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A renal biopsy with immunostaining study was performed, revealing deposition of amyloid A in all 34 glomeruli and vascular walls with apple-green birefringence upon examination of Congo red-stained tissue under polarized light microscopy (Fig. 2).
Left panel: ileal biopsy revealing the presence of deposits of an amorphous substance on the ileal mucosa, predominantly in the submucosa and vessel wall, highlighted by Congo red staining (200x). Right panel: ileal biopsy showing apple-green birefringence on observation with polarized light
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As the patient maintained watery diarrhoea without an infectious cause identified and to evaluate for another manifestation of amyloidosis, a colonoscopy with biopsy was performed and showed amyloid deposition (Fig. 3) without signs of inflammatory bowel disease.
Thoracic x-ray showing hyperostosis at the proximal extremities of the clavicles and in some sterno-costal joints
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Full-body bone scintigraphy revealing multifocal (sternocostoclavicular, sacroiliac joints, left mandibular branch) hypercaptation of the radiopharmaceutical agent
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Therefore, 99mTc bone scintigraphy was performed and showed multifocal (sternocostoclavicular, sacroiliac joints, left mandibular branch) hypercaptation (Fig. 5).