Destructive spondyloarthropathy.

摘要

A 50-year-old patient was referred after incidental finding of a lytic lumbar spine lesion after he underwent hemodialysis for 3 years. A sagittal computed tomography image demonstrated a large expansile osteolytic lesion within the posterior elements of L4 and, to a lesser extent, L5. Bone biopsy histology demonstrated pink amorphous material with surrounding giant-cell inflammation. The material stained orange-red by Congo red and then exhibited apple-green birefringence under polarized light. The patient's serum level of beta2-microglobulin measured50 mg per liter (reference range 1.5-2.3 mg per liter). Together with the immunohistological identification of beta2-microglobulinas the major amyloid deposit constituent, the diagnosis of dialysis-related amyloidosis was established. Our patient had minimal symptoms (except mild carpal tunnel syndrome) and was not keen for spinal fusion; he was wait-listed for renal transplantation. This case illustrates a unique form of systemic amyloidosis with predominant osteoarticular manifestation associated with carpal tunnel syndrome.