1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Michael J Cirivello Affiliation: Uniformed Services University

2. MedPix No: 6247 - History Pt Demographics: Age = 58 y.o. Gender = woman 58 year old Hispanic female who developed asymptomatic plaques under her right eye 8 years ago. Approximately 1 year later she developed similar lesions on her chest and under her left eye. She denies any change in number or size of these lesions over the past 7 years. The lesions become red with rubbing. There is no history of weight loss, fatigue, paresthesia, hoarseness, rectal bleeding, melena, bone pain or fractures.She has no history of dry eyes or carpal tunnel syndrome. Downloaded by (-1)

3. MedPix No: 6247 - EXAM & LABS PHYSICAL EXAM:Bilateral lower eyelids with 0.5-l.0 cm firm, yellow-brown plaques with surrounding 1-2 mm petechiae. Mid-chest with scattered 0.5-l.0 cm firm yellow plaques with a hemorrhagic appearance. No macroglossia and no oral mucosa lesions. LABORATORY: SPEP + UPEP = WNL w/o any monoclonal spike. Quantitative analysis of immunoglobulins - WNL. BUN/CR = WNL. CA/P = WNL. CXR, U/A, CBC and platelets = WNL.HISTOPATHOLOGY: pale eosinophilic material is present throughout thedermis, especially in a perivascular distribution. Focal collections of plasma cells are adjacent to this material.

4. PRIMARY LOCALIZED CUTANEOUS NODULAR AMYLOIDOSIS Downloaded by (-1)

5. PRIMARY LOCALIZED CUTANEOUS NODULAR AMYLOIDOSIS Downloaded by (-1)

6. PRIMARY LOCALIZED CUTANEOUS NODULAR AMYLOIDOSIS Downloaded by (-1)

7. PRIMARY LOCALIZED CUTANEOUS NODULAR AMYLOIDOSIS Downloaded by (-1)

8. FINDINGS

9. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis?

10. Diagnosis: PRIMARY LOCALIZED CUTANEOUS NODULAR AMYLOIDOSIS (1997 Uniformed Services Dermatology Seminar, Case#27) submitted by: LT Joseph McKinlay, MC, USNR Dx Confirmed by:

11. DISCUSSION