An interesting case courtesy of this week’s NEJM:
A 66-year-old man presented with a two-year history of fatigue, paresthesia of the legs and feet, weight loss, and shoulder enlargement, with limitation of movement. On physical examination, periorbital ecchymoses (the “raccoon” sign) and infiltration of the periarticular tissues of the shoulders were found.
A biopsy specimen of abdominal fat that was stained with Congo red was positive for amyloid, and serum monoclonal paraprotein (lambda light chain) was detected by immunoelectrophoresis.
The “shoulder pad” sign is an enlargement of the anterior shoulder due to fluid in the joint and/or amyloid infiltration of the synovial membrane and surrounding structures. This type of soft tissue swelling can occur in up to 75% of amyloid cases.
The following X-ray demonstrates the shoulder pad sign (from UptoDate):
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{ 3 comments }
I have a question, im 22 years old and I experience really bad shoulder pain in mostly my right shoulder but both sometimes. Sometimes its barable but mostly not. And I can almost feel the bones inside popping and maybe grinding eachother? I cant explain it but is this something I should worry about. I informed my doctor and she took X-rays and found nothing? Sorry to bug with this but any professional insight would be helpful.
Can polio cause this condition? this man looks remarkably similar to my husband (only this man does not have the severe scoliosis curves & kyphoscoliosis my husband has)My husband is JUST as skinny, complete with the muscle atrophy and the shoulders looking swollen or enlarged. My husband is 5′4″ on one foot, 5′0″ on the other, the orthopedic says that he would have been 6″3″ without having had polio. He is large boned and weighs 98 lbs. I never quite realized just HOW skinny & emaciated he looked until our now 13 year old son, then 8 year old son, was watching a documentary on the holocaust with us and turned to his dad as they were throwing the bodies into a mass grave and said “Daddy, did they have polio too?” At that point, I realized just how severe his was. Other than the holocaust documentary, THIS man, is the only other human I have seen a picture of who even comes close to being as skinny as my husband ..sooo … I’m wondering … could polio have been the precurser to this man’s condition? ???
Wow.. I’ve read about amyloidosis and known one person with it, but never have I seen a photo of its toll… Very informative post, thanks!
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