A 53-year-old man complained of orthostatic, non-rotating dizziness, and chronic watery diarrhea of several years duration. His nerve-conduction velocity test revealed peripheral sensory-motor polyneuropathy and he showed an autonomic function abnormality. Echocardiographic examination showed ventricular and atrial wall thickening with a granular "sparkling" appearance. Left ventricular systolic function was preserved but pseudonormal diastolic dysfunction was present. Coronary angiography showed normal coronary arteries and an endomyocardial biopsy revealed lesions consistent with cardiac amyloidosis. Colonoscopic biopsy also revealed the deposition of amyloid fibrils. Gene analysis found the transthyretin variant Asp38Ala. His son had same mutation, but three daughters did not. In conclusion, we report a case of familial transthyretin amyloidosis with Asp38Ala.
Amyloid ; Amyloid Neuropathies, Familial ; Amyloidosis ; Biopsy ; Coronary Angiography ; Coronary Vessels ; Diarrhea ; Dizziness ; Hypotension, Orthostatic ; Nuclear Family ; Polyneuropathies ; Prealbumin

BACKGROUND AND PURPOSE: Tafamidis functions to delay the loss of function in transthyretin familial amyloid polyneuropathy (TTR-FAP), which is a rare inherited amyloidosis with progressive sensorimotor and autonomic polyneuropathy. This systematic literature review and meta-analysis evaluated the efficacy and safety of tafamidis in TTR-FAP patients, with the aim of improving the evidence-based medical evidence of this treatment option for TTP-FAP. METHODS: A systematic search of the English-language literature in five databases was performed through to May 31, 2018 by two reviewers who independently extracted data and assessed the risk of bias. We extracted efficacy and safety outcomes and performed a meta-analysis. Statistical tests were performed to check for heterogeneity and publication bias. RESULTS: The meta-analysis identified six relevant studies. The tafamidis group showed smaller changes from baseline in the Neuropathy Impairment Score–Lower Limbs [mean difference (MD)=−3.01, 95% confidence interval (CI)=−3.26 to −2.75, p < 0.001] and the Norfolk Quality of Life-Diabetic Neuropathy total quality of life score (MD=−6.67, 95% CI=−9.70 to −3.64, p < 0.001), and a higher modified body mass index (MD=72.45, 95% CI=69.41 to 75.49, p < 0.001), with no significant difference in total adverse events [odds ratio (OR)=0.69, 95% CI=0.35 to 1.35, p=0.27]. The incidence of adverse events did not differ between tafamidis and placebo treatment except for fatigue (OR=0.13, 95% CI=0.02 to 0.72, p=0.02) and hypesthesia (OR=0.16, 95% CI=0.03 to 0.92, p=0.04). CONCLUSIONS: This systematic review and meta-analysis has demonstrated that tafamidis delays neurologic progression and preserves a better nutritional status and the quality of life. The rates of adverse events did not differ between the patients in the tafamidis and placebo groups. Tafamidis might be a safer noninvasive option for patients with TTR-FAP.
Amyloid Neuropathies ; Amyloid Neuropathies, Familial* ; Amyloidosis ; Bias (Epidemiology) ; Body Mass Index ; Extremities ; Fatigue ; Humans ; Hypesthesia ; Incidence ; Nutritional Status ; Polyneuropathies ; Population Characteristics ; Prealbumin* ; Publication Bias ; Quality of Life

Familial amyloidotic polyneuropathy (FAP) is a rare hereditary amyloidosis that is characterized by slowly progressive peripheral polyneuropathy with other systemic involvement. More than 100 amyloidogenic transthyretin gene mutations have been reported, mainly in endemic areas of Portugal, Japan, and Sweden. We describe two brothers who exhibited progressive painful sensorimotor polyneuropathy with autonomic dysfunction. Gene analysis revealed a heterozygous Asp38Ala substitution in the transthyretin gene; this represents the first reported case of FAP in Korea.
Amyloidosis ; Amyloidosis, Familial ; Humans ; Japan ; Korea ; Polyneuropathies ; Portugal ; Prealbumin ; Siblings ; Sweden

The primary localized cutaneous amyloidosis (PLCA) is classified into three types: macular amyloidosis, lichen amyloidosis, and nodular amyloidosis. Macular amyloidosis is characterized by pruritic, hyperpigmented macules and is most commonly located on the interscapular area. Skin lesion usually shows pigmentation with a reticulated or rippled pattern. We report an unusual case of linear macular amyloidosis along the lines of Blaschko. A 74-year-old male is presented with asymptomatic unilateral linear hyperpigmented macules on his right leg for 20 years. Skin biopsy has revealed eosinophilic cytokeratin-positive globular deposits occupying the dermal papillae.
Amyloidosis ; Amyloidosis, Familial ; Biopsy ; Eosinophils ; Humans ; Leg ; Lichens ; Male ; Pigmentation ; Skin ; Skin Diseases, Genetic

Amyloidosis is defined by the extracellular deposition of fibrillar proteinacious material that binds Congo red dye. Amyloid fibrils can be deposited locally, but can involve virtually every organ system of the body. Hereditary, autosomal dominant amyloidosis, caused by mutations in the genes encoding transthyretin, fibrinogen Aalpha-chain, lysozyme or apolipoprotein A-I, is-extremely rare. A case of familial amyloidosis, involving the heart, was identified, where the patient complained exertional dyspnea. The echocardiographic findings were the markedly thickened the interventricular septum and right ventricular wall, as well as a granular sparkling appearance in the interventricular septum. On admission, the patient, and his younger brother, underwent endomyocardial biopsies, and the results of the Congo red staining and EM were consistent with amyloidosis. The patient was managed conservatively, and discharged without complication.
Amyloid ; Amyloidosis* ; Amyloidosis, Familial ; Apolipoprotein A-I ; Biopsy ; Congo Red ; Dyspnea ; Echocardiography ; Fibrinogen ; Heart ; Humans ; Muramidase ; Prealbumin ; Siblings

Amyloidosis is defined by the extracellular deposition of fibrillar proteinacious material that binds Congo red dye. Amyloid fibrils can be deposited locally, but can involve virtually every organ system of the body. Hereditary, autosomal dominant amyloidosis, caused by mutations in the genes encoding transthyretin, fibrinogen Aalpha-chain, lysozyme or apolipoprotein A-I, is-extremely rare. A case of familial amyloidosis, involving the heart, was identified, where the patient complained exertional dyspnea. The echocardiographic findings were the markedly thickened the interventricular septum and right ventricular wall, as well as a granular sparkling appearance in the interventricular septum. On admission, the patient, and his younger brother, underwent endomyocardial biopsies, and the results of the Congo red staining and EM were consistent with amyloidosis. The patient was managed conservatively, and discharged without complication.
Amyloid ; Amyloidosis* ; Amyloidosis, Familial ; Apolipoprotein A-I ; Biopsy ; Congo Red ; Dyspnea ; Echocardiography ; Fibrinogen ; Heart ; Humans ; Muramidase ; Prealbumin ; Siblings

Primary localized cutaneous amyloidosis is classified as macular, lichen, and rarely nodular amyloidosis according to clinical manifestation. Most cases are sporadic, but several cases have been reported to be familial with autosomal dominant transmission. Herein, we report a patient with familial primary localized cutaneous amyloidosis suggesting autosomal dominant transmission. A 31-year old woman presented with pruritic brown hyperkeratotic papules on both legs which developed 5 years ago and gradually had spread around the knee. A skin biopsy showed an amorphous eosinophilic material in the papillary dermis that appeared pink with congo red stain. Her mother and older sister have also suffered from similar pruritic brown papules on the legs without any kind of manifestation suggesting the disease is systemic.
Amyloidosis ; Amyloidosis, Familial ; Biopsy ; Congo Red ; Dermis ; Eosinophils ; Female ; Humans ; Knee ; Leg ; Lichens ; Mothers ; Siblings ; Skin ; Skin Diseases, Genetic

Amyloidosis is a group of disorders characterized by the extracellular accumulation of insoluble, fibrillar proteins in various organs and tissues. It is classified, on the basis of the identity of the precursor protein, as primary, secondary, or familial amyloidosis. Gastrointestinal amyloidosis usually presents as bleeding, ulceration, malabsorption, protein loss, and diarrhea. However, gastric amyloidosis with gastric outlet obstruction mimicking linitis plastica is rare. We report a case of gastrointestinal amyloidosis with gastric outlet obstruction in a patient with ankylosing spondylitis. The patient was indicated for subtotal gastrectomy because of the aggravation of obstructive symptoms, but refused the operation and was transferred to another hospital. Three months later, the patient died of aspiration pneumonia during medical treatment.
Amyloidosis* ; Amyloidosis, Familial ; Diarrhea ; Gastrectomy ; Gastric Outlet Obstruction* ; Hemorrhage ; Humans ; Linitis Plastica ; Pneumonia, Aspiration ; Spondylitis, Ankylosing* ; Ulcer

Familial Mediterranean fever (FMF) is an auto-inflammatory disease characterized by periodic episodes of fever and recurrent polyserositis. It is caused by a dysfunction of pyrin (or marenostrin) as a result of a mutation within the MEFV gene. It occurs mostly in individuals of Mediterranean origin; however, it has also been reported in non-Mediterranean populations. In this report, we describe the first case of FMF in a Korean child. As eight-year-old boy presented recurrent febrile attacks from an unknown cause, an acute scrotum and renal amyloidosis. He also showed splenomegaly, lymphadenopathy, pleural effusion, ascites and elevated acute phase reactants. After MEFV gene analysis, he was diagnosed as FMF combined with amyloidosis.
Amyloidosis/*diagnosis ; Child ; Familial Mediterranean Fever/*diagnosis ; Humans ; Kidney Diseases/*diagnosis ; Korea ; Male

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with amyloidosis cutis dyschromica. METHODS: High-throughput sequencing was carried out for the proband. Bioinformatic analysis was used to identify the pathogenic variants. The result was verified by Sanger sequencing. RESULTS: A homozygous nonsense variant c.565C>T (p.Arg189X) of the GPNMB gene was identified in the proband, his elder brother and younger sister, which resulted a truncated protein with loss of function. The father of the proband was a heterozygous carrier for the variant. The genotype of his mother was unknown since she had passed away. Based on the American College of Medical Genetics and Genomics standards and guidelines, the c.565C>T variant was predicted to be likely pathogenic (PS3+ PM2+ PP1+PP3). CONCLUSION The novel homozygous GPNMB variant probably underlay the amyloidosis cutis dyschromica in this pedigree. Above finding has expanded the spectrum of GPNMB gene variants.
Amyloidosis, Familial/genetics* ; China ; Female ; Homozygote ; Humans ; Male ; Membrane Glycoproteins/genetics* ; Mutation ; Pedigree