Scalp Biopsy Identifies Systemic Amyloidosis Presenting as Isolated Telogen Effluvium: A Case Report
January 2019
in “
SAGE Open Medical Case Reports
”
telogen effluvium diffuse alopecia areata catagen phase telogen phase scarring alopecia perifollicular deposition amyloid systemic amyloidosis lambda AL amyloidosis B-cell dyscrasias multiple myeloma plasma-cell dyscrasia plasma cells bone marrow melphalan renal impairment proteinuria hair loss hair shedding hair thinning scalp biopsy amyloid deposits bone marrow disorder kidney issues
TLDR A scalp biopsy revealed systemic amyloidosis in a woman who initially seemed to have a common hair loss condition.
In 2019, a case report described a 74-year-old woman who presented with diffuse scalp alopecia, initially suspected to be telogen effluvium or diffuse alopecia areata. However, scalp biopsies revealed a large proportion of hair follicles in the catagen and telogen phases, with no signs of scarring alopecia. Remarkably, the biopsies also showed perifollicular deposition of amyloid, which is characteristic of systemic amyloidosis. This prompted further investigation, leading to the diagnosis of lambda AL amyloidosis, a type of systemic amyloidosis associated with B-cell dyscrasias or multiple myeloma. The patient was found to have an occult plasma-cell dyscrasia with 8% plasma cells in the bone marrow and received treatment with melphalan. The case highlights the importance of considering systemic amyloidosis in the differential diagnosis of alopecia and demonstrates the utility of scalp biopsy in identifying underlying systemic conditions. The patient's disease was stable at the time of publication, with no known involvement of major organs except for mild renal impairment and proteinuria.
