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Year : 2010  |  Volume : 76  |  Issue : 2  |  Page : 216

Fatigue, macroglossia, xanthomatous papules and bullae

Department of Dermatology, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, India

Date of Web Publication10-Mar-2010

Correspondence Address:
Sanjay Singh
C-9 New Medical Enclave, Banaras Hindu University, Varanasi - 221 005
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0378-6323.60547

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How to cite this article:
Singh S, Kumar S, Chaudhary R. Fatigue, macroglossia, xanthomatous papules and bullae. Indian J Dermatol Venereol Leprol 2010;76:216

How to cite this URL:
Singh S, Kumar S, Chaudhary R. Fatigue, macroglossia, xanthomatous papules and bullae. Indian J Dermatol Venereol Leprol [serial online] 2010 [cited 2020 Aug 3];76:216. Available from:

A 45-year-old man had fatigue, nail dystrophy (thinning, striations) (13 months); diffuse scalp alopecia, macroglossia, dysphagia (4 months); xanthomatous lesions, hoarseness, generalized pruritus (3 months); and bullae (6 weeks). Except pallor and expressionless face, general and systemic examination was normal. Itchy, xanthomatous papules were present on the back [Figure 1], and tense vesicles and bullae, some with hemorrhagic fluid, were on the limbs and abdomen.

Hemoglobin was 7.8 g/dl, and ESR was 31 mm. Blood counts, routine urinalysis, and serum biochemistry including calcium level, X-rays and ultrasonography (abdomen) were normal. The 24-h urinary protein was 360 mg/dl. Skin biopsy [Figure 2] and bone-marrow examination [Figure 3] were performed.

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1.Nyirady J, Schwartz RA. Amyloidosis, primary systemic. Available from: . [last accessed on 2009 May 10]  Back to cited text no. 1      
2.Lachmann HJ, Hawkins PN. Amyloidosis and the skin. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick′s dermatology in general medicine. 7 th edition. New York: McGraw-Hill; 2008. p. 1257-65.  Back to cited text no. 2      
3.Silverstein SR. Primary systemic amyloidosis and the dermatologist: Where classic skin lesions may provide the clue for early diagnosis. Dermatol Online J 2005;11:5.  Back to cited text no. 3      
4.Palladini G, Perfetti V, Obici L, Caccialanza R, Semino A, Adami F, et al. The association of melphalan and high-dose dexamethasone is effective and well tolerated in patients with AL (primary) amyloidosis ineligible for stem cell transplantation. Blood 2004;103:2936-8.  Back to cited text no. 4  [PUBMED]    
5.Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, et al. High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: An 8-year study. Ann Intern Med 2004;140:85-93.  Back to cited text no. 5  [PUBMED]    
6.Kyle RA, Rajkumar SV. Treatment of multiple myeloma: a comprehensive review. Clin Lymphoma Myeloma 2009;9:278-88.  Back to cited text no. 6  [PUBMED]    


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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