title: Primary amyloidosis presenting as upper limb multiple mononeuropathies.
abstract: Peripheral neuropathy in primary (AL) amyloidosis is usually lower-limb predominant, length-dependent, symmetrical, and affects small (pain and autonomic) fibers, as much or more than large fibers. We report a patient with stepwise progressive, multiple upper limb mononeuropathies that were due to nerve biopsy-proven primary amyloidosis (lambda light chain), with no systemic or autonomic features. Recognition that light chain amyloidosis may be the cause of a multiple mononeuropathy pattern adds to the differential diagnosis of this clinical phenotype.
authors.affiliation: Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Tracy
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dyck
authors.forename: P James B
authors.initials: PJ
authors.lastname: Dyck
mesh_terms: D000368:Aged; D017772:Amyloid Neuropathies / Q000473:pathology* / Q000503:physiopathology; D000686:Amyloidosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D001706:Biopsy; D003937:Diagnosis, Differential; D018450:Disease Progression; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000032:analysis / Q000378:metabolism; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D020422:Mononeuropathies / Q000235:genetics / Q000473:pathology* / Q000503:physiopathology; D009431:Neural Conduction / Q000502:physiology; D010525:Peripheral Nerves / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D000069283:Rituximab; D012680:Sensitivity and Specificity; D017211:Treatment Failure
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D007147:Immunoglobulin Light Chains; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab
references.citation: Neurology. 1981 Apr;31(4):461-3
references.pmid: 7194438
references.citation: Arch Neurol. 1969 May;20(5):490-507
references.pmid: 5813888
references.citation: Muscle Nerve. 2004 Feb;29(2):318-22
references.pmid: 14755500
references.citation: J Peripher Nerv Syst. 2006 Dec;11(4):346-52
references.pmid: 17117943
references.citation: Blood. 1991 Jan 15;77(2):257-62
references.pmid: 1985692
references.citation: Ann Neurol. 1979 Jul;6(1):1-7
references.pmid: 228587
references.citation: N Engl J Med. 2001 Mar 22;344(12):917-23
references.pmid: 11259726
references.citation: Neurology. 1993 Aug;43(8):1500-8
references.pmid: 8351002
references.citation: Arch Pathol Lab Med. 2000 Jan;124(1):114-8
references.pmid: 10629141
references.citation: Best Pract Res Clin Haematol. 2005;18(4):709-27
references.pmid: 16026746
references.citation: Spine (Phila Pa 1976). 1998 Jan 1;23(1):133-8
references.pmid: 9460163
references.citation: Muscle Nerve. 2009 Sep;40(3):363-70
references.pmid: 19618439
references.citation: Am J Med. 1998 Mar;104(3):232-7
references.pmid: 9552085
references.citation: Cancer. 1998 Jan 15;82(2):362-74
references.pmid: 9445195
references.citation: Clin Neurol Neurosurg. 2003 Jul;105(3):167-9
references.pmid: 12860508