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A 60-year-old woman with a 13-year history of monoclonal gammopathy of unknown significance (MGUS) presented with worsening nail dystrophy. Prior workup for systemic amyloidosis had been unrevealing, and no other signs of cutaneous disease were present. Nail biopsy was consistent with amyloid deposition, and the patient subsequently underwent autologous hematopoietic stem cell transplantation for AL amyloidosis. In light of the growing literature regarding nail changes as a presenting sign of systemic amyloidosis and the promising utility of nail biopsy, we suggest a low threshold for biopsy in appropriate patients when nail changes characteristic of amyloidosis are refractory to conventional treatment.
2. Quarta CC, Gonzalez-Lopez E, Gilbertson JA, et al. Diagnostic sensitivity of abdominal fat aspiration in cardiac amyloidosis. Eur Heart J. 2017; ehx047. doi: 10.1093/eurheartj/ehx047.
3. Rao RR, Yong WC, Wasko MC. Systemic Light Chain Amyloidosis Mimicking Rheumatic Disorders. Case Rep Med. 2016; 2016: 7649510. doi: 10.1155/2016/7649510.
4. Que SKT, Sloan B, Dadras SS. Trachyonychia, Cutis Laxa, and Easy Bruising of the Skin. JAMA Dermatol. 2014; 150: 1357-1358.
5. Fernandez-Flores A, Castañón-González JA, Guerrero-Ramos B, et al. Systemic amyloidosis presenting with glans penis involvement. J Cutan Pathol. 2014; 41: 791-796.
6. Oberlin KE, Wei EX, Cho-Vega JH, Tosti A. Nail Changes of Systemic Amyloidosis After Bone-Marrow Transplantation in a Patient With Multiple Myeloma. JAMA Dermatol. 2016; 152: 1395-1396.
7. Shim JH, Oh SH, Jun JY, et al. Trachyonychia as the presenting sign of myeloma-associated amyloidosis. Int J Dermatol. 2016; 55: e410-e412.
8. Barja J, Piñeyro F, Almagro M, et al. Systemic amyloidosis with an exceptional cutaneous presentation. Dermatol. Online J. 2013; 19(1).
9. Xu J, Tahan S, Jan F, et al. Nail dystrophy as the initial sign of multiple myeloma-associated systemic amyloidosis. J Cutan Pathol. 2016; 43: 543-545.
10. Ahmed I, Cronk JS, Crutchfield CE, Dahl MV. Myeloma-associated systemic amyloidosis presenting as chronic paronychia and palmodigital erythematous swelling and induration of the hands. J Am Acad Dermatol. 2000; 42: 339-342.
11. Tausend W, Neill M, Kelly B. Primary amyloidosis-induced nail dystrophy. Dermatol. Online J. 2014; 20(1).
12. Etienne M, Denizon N, Maillard H. Anomalies unguéales révélant une amylose systémique AL. Rev Med Interne. 2015; 36: 356-358.