An unusual case of AL amyloidosis presenting as alopecia and nail changes

Excerpt

An 81 year-old woman with no known medical history was referred to a rheumatology clinic with bilateral hand joint pain. She reported extensive hair loss and fingernail changes in the last few months. Physical examination revealed alopecia of the scalp, particularly in the frontal and temporal regions (Fig. 1a, b). In addition, onychodystrophy with longitudinal ridging of the hand nails was observed (Fig. 1c). Examination and imaging of hand joints were compatible with degenerative joint disease. A month earlier, the patient was evaluated in a dermatology clinic, and a diagnosis of classic lichen planopilaris or fibrosing alopecia with pattern distribution was considered. Nail changes were considered to be related to nail lichen planus. A scalp biopsy was suggested, but the patient declined.

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