Secondary Amyloidosis Presenting as Oral Nodules

Abstract

econdary, or reactive amyloidosis is a type of systemic amyloidosis seen in patients with chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease, sarcoidosis, and tuberculosis. It results from proliferation and subsequent deposition of an acute-phase protein called serum amyloid A in tissues. Clinical features are usually slow to develop. The first manifestations are usually proteinuria and renal dysfunction. The severity of renal involvement determines prognosis of the patient. Liver and heart involvement may also be seen.1,2 Oral involvement with secondary amyloidosis is exceedingly rare. The most frequently affected site is the tongue. The protein deposition usually results in generalized or nodular macroglossia. More diffuse involvement of the oral cavity has also been reported as yellow nodules, or generalized ulceration.3,4 Here we present a case of a 63-year-old Pakistani female who was first diagnosed with secondary amyloidosis following a biopsy of her oral nodules, despite being under the care of multiple physicians for her systemic complaints. Our case emphasizes the need of multidisciplinary practice in Pakistan. CASE REPORT