Primary Amyloidosis Presenting as Extensor Tenosynovitis

Abstract

Primary amyloidosis is a systemic disease. Amyloid arthropathy is an invalidating and uncommon form of presentation, but tenosynovitis is even rarer as the first sign of the disease. We report herein a case of unilateral amyloid deposit in the synovium of the extensor tendons of the hand, which was the first manifestation of a primary amyloidosis.

Sonographic Evaluation of Extensor Tenosynovitis

“…Amyloid deposition in this location has been described in patients with primary amyloidosis and in those on chronic hemodialysis. 17,18 Additionally, the presence of multiple subchondral cysts and carpal instability suggests the possibility of CPPD. A type of crystalline arthropathy, CPPD can also result in tenosynovitis.…”

Management of systemic risk factors for chronic tendinopathy

“…It should also be noted, in the panel of intercurrent inflammatory pathologies, that several cases of amyloidosis have described spontaneous tendon ruptures and tenosynovites as first symptoms. The mechanism of action on tendon is not known but probably linked with to the effects (poten-tially inflammatory) of amyloid deposits in the tendon or synovial sheath [44].…”