Multiple myeloma-associated amyloidosis and giant cell arteritis

Abstract

Primary systemic amyloidosis has been associated with the development of symptoms and clinical features characteristic of polymyalgia rheumatica and/or giant cell arteritis (GCA). Case reports of this clinical entity have been published, stating that the amyloid deposition leads to the symptoms of vasculitis. In this report, we present a second case in the English literature of a patient presenting with multiple myeloma-associated amyloidosis and GCA. This is the first case in which the histopathologic findings are described in enough detail to suggest a pathogenic relationship between the two diseases.

Masquerades of Giant Cell Arteritis Evident on Temporal Artery Biopsy

“…The final cases included, representing 32 patients over 50 years of age, are summarized in Table 1. The most common finding (19 cases) in the temporal artery biopsy from these reports was the deposition of eosinophilic material with positive staining for Congo-red, indicating amyloidosis 9–23 . In some cases, the amyloid was not readily apparent on the temporal artery biopsy, and only after a second review with Congo-red staining was the amyloid obvious, 19 and in other cases there were findings suggestive of both GCA and amyloid deposition from multiple myeloma, indicating that the two diagnoses can sometimes co-exist 9,21 .…”

“…The most common finding (19 cases) in the temporal artery biopsy from these reports was the deposition of eosinophilic material with positive staining for Congo-red, indicating amyloidosis. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In some cases, the amyloid was not readily apparent on the temporal artery biopsy, and only after a second review with Congo-red staining was the amyloid obvious, 19 and in other cases there were findings suggestive of both GCA and amyloid deposition from multiple myeloma, indicating that the two diagnoses can sometimes co-exist. 9,21 The finding of focal necrotizing vasculitis in small vessels adjacent to the temporal artery or in the adventitia supported the diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (eight cases), [24][25][26][27][28][29][30] polyarteritis nodosa (two cases) 31,32 or Hepatitis C-associated cryoglobulinemia (one case) 35 in patients that had systemic symptoms consistent with GCA.…”

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“…También es conocida la asociación de ACG con gammapatía monoclonal (GM), descripta por primera vez en 1980 por Calamia et al en 100 pacientes con ACG, y en dos de ellos se diagnostica en forma concurrente GM sin mieloma (IgG-kappa) 40 . Estrada et al en 1998 describieron 5 casos de ACG y GM sobre un total de 33 pacientes examinados (15.2%) 41 . La ACG ha sido asociada con amiloidosis sistémica primaria, lo cual sugiere un posible rol del depósito de amiloide para el desarrollo de esta vasculitis.…”

Necrotizing Angiitis of the Small Intestine Related to AA-Amyloidosis: A Novel Association

“…One case of amyloid angiopathy and cerebral vasculitis was reported in a patient who had long-standing rheumatoid arthritis, but the amyloid was not chemically typed [12]. Estrada et al [18] described a patient with multiple myeloma who had X light chain-derived AL-amyloid deposits associated with giant cell temporal arteritis, and there are several additional case reports of temporal arteritis associated with amyloid deposits of unknown type [13,14]. In this report, we document AA-amyloid angiopathy associated with a destructive vasculitis in submucosal blood vessels of the gastrointestinal tract and demonstrate immunohistochemically that monocyte/macrophages are intimately associated with these deposits.…”