(Kiosk 1) Rare Presentation of Foot Pain from Dialysis-associated Amyloidosis: A Case Report

Case Diagnosis: Rare Presentation of Foot Pain from Dialysis-Associated Amyloidosis

Case Description or Program Description: 53-year-old male with ESRD on HD admitted to acute inpatient rehabilitation for impaired ADL and mobility after a recent NSTEMI which required a three vessel CABG. He complained of bilateral foot pain limiting his therapy participation. He was also noted to have dry gangrene involving his left foot secondary to peripheral vascular disease. However, during his rehabilitation course, he continued to complain of bilateral foot pain which prompted additional investigation. X-rays showed bilateral foot lucent/lytic lesions on the feet, more right than left side. MRI was also eventually recommended, and this showed erosive arthropathy, greatest involving the second MTP joint with associated soft tissue component, indicative of dialysis-associated amyloidosis.

Setting: Acute Inpatient Rehabilitation (AIR) Hospital

Assessment/Results: Patient with a unique case and presentation of dialysis-associated amyloidosis involving the feet. He had significant pain, which limited his therapy participation and medical treatments options were limited due to his medical history.

Discussion (relevance): Dialysis-associated amyloidosis is a disabling disease characterized by accumulation and tissue disposition of amyloid fibrils consisting of beta2-microglobulin in the bone, periarticular structures, and viscera of patients with CKD. The most common complaint is shoulder pain and symptoms of carpal tunnel syndrome [1,2]. Bone articular lesions with shoulder, wrist, knee or hip joint pain were the most common respectively [1,2]. Amyloid bone lesions are rare [3]. These lesions occur exclusively in cases of amyloidosis secondary to plasma cell dyscrasia [4]. This case report presents a unique presentation with buildup in MTP joint of the foot causing erosive arthropathy with associated soft tissue component causing foot pain. There is no specific medical treatment of dialysis-associated amyloidosis.

Conclusions: This case demonstrates a unique case of a patient with dialysis-associated amyloidosis contributing to foot pain. Diagnosis is based on presence of clinical features pain with characteristic imaging findings. It commonly develops in patients undergoing long-term dialysis and can lead to a decline in activities of daily living and quality of life [1]. More studies and research are yet to be done to understand and determine specific treatment plan other than renal transplantation.