case_images: PMC5943088_01
case_images: Images of CT, MRI, and 18F-FDG PET of the patients. (A) A representative image of computed tomography of right shoulder. Damaged shoulders (shown by arrows) surrounded by low-density soft tissue was shown. (B) T2-STIR magnetic resonance images of the right knee. A low-intensity area (shown by thick allow) of amyloid deposits and a high-intensity area (shown by thin allow) representing fluid collection. (C) Images of 18F-FDG positron-emission computed tomography. FDG uptake in the large joints was shown with arrows. CT = computed tomography, DRA = dialysis-related amyloidosis, FDG = fluorodeoxyglucose, MRI = magnetic resonance imaging, STIR = T2-weighted short-tau inversion recovery.
case_images: medi-97-e9359-g002.jpg
case_images: PMC5943088_01_medi-97-e9359-g002.jpg
case_images: F1
case_images: Computed tomography (CT) of bilateral shoulder joints, humeri, and hip joints showed severely damaged lytic bone lesions surrounded by low density soft tissue (Fig. 1A). A T2-weighted short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) of the right knee joint showed a low-intensity area with fluid collection (Fig. 1B). Positron emission tomography-CT with [18F]-fluorodeoxyglucose (FDG) demonstrated abnormal FDG uptake in the large joints (standardized uptake value max: 7.6) as shown in Fig. 1C.
case_images: Histological images of synovium samples of the case. (A) Hematoxylin-eosin staining of the synovial tissue. Prominent lymphocytic and plasmacytic infiltration beneath enlarged synovial lining cells. Amorphous eosinophilic material depositions were seen around capillaries (arrow) (x200). (B) Congo-red staining of synovial tissue. The amorphous materials were stained orange-red (arrow) (x200). (C) beta2-MG deposition of synovial tissue by immunohistochemistry. Browny staining showed deposition of beta2-MG (x200). beta2-MG = beta2-microglobulin.
case_images: medi-97-e9359-g003.jpg
case_images: PMC5943088_01_medi-97-e9359-g003.jpg
case_images: F2
case_images: Amorphous eosinophilic material depositions were seen around capillaries (Fig. 2A), which were also stained as orange-red by Congo-red staining (Fig. 2B). Also, beta2-MG was positively detected by immunohistochemistry (Fig. 2C).
case_images: The clinical course after treatment intervention. CRP = C-reactive protein, beta2-MG = beta2-microglobulin, PES = polyethersulfone.
case_images: medi-97-e9359-g004.jpg
case_images: PMC5943088_01_medi-97-e9359-g004.jpg
case_images: F3
case_images: Then, we finally confirmed normalization of the high levels of inflammatory marker and fever with his articular symptoms improved in January 2017 (Fig. 3).