[Bullous amyloidosis].
BACKGROUND
The occurrence of skin damage during systemic amyloidosis is common, but the appearance of bullous lesions is rare. Only twenty-seven cases have been reported in the literature. We report our observation of bullous amyloidosis during progression of renal amyloidosis.


METHODS
A 61 year-old man, presented with white, soft, palpebral edemas of the lower limbs, without scutulum involvement, associated with a large cubital nerve that had appeared in March 1997. Biological explorations revealed a nephrotic syndrome. Pathologic study of the renal biopsy concluded in amyloidosis. Treatment with colchinine stabilized the renal damage. One year later, a non-pruriginous, papular and bullous eruption occurred, localized essentially in the axillary and inguinal-crural folds of the forearms and legs. In the presence of an amyloidal deposit and intra-epidermal detachment, the cutaneous biopsy was evocative of bullous amyloidosis. The search for concomitant myeloma was negative. Treatment with colchinine was effective. The bullous lesions disappeared after 2 months, and 21 months later, renal damage was still stable.


CONCLUSIONS
These particularities in evolution are exceptional and have never been described. A hypothetical modification in the physico-chemical properties of the amyloidal protein might explain the bullous eruption and stabilization of renal damage.
Houman
M H
MH
Service de Médecine Interne, Hôpital la Rabta, Tunis, Tunisie. houman.habib@rns.tn
Smiti Khanfir
M
M
Ben Ghorbel
I
I
Mokni
M
M
Jerbi
E
E
Boubaker
S
S
Ben Osman Dhari
A
A
Miled
M
M
D000686:Amyloidosis / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012872:Skin Diseases, Vesiculobullous / Q000209:etiology* / Q000473:pathology