Bullous amyloidosis in a hemodialysis patient is myeloma-associated rather than hemodialysis-associated amyloidosis

Shyue Luen Chang, Ping Chin Lai, Chien Jui Cheng, Li Cheng Yang, Hong Shang Hong

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


We report a 78-year-old woman on hemodialysis who presented with refractory multiple pruritic vesicles and bullae on her trunk and extremities for 2 months. Histopathologic examination of skin biopsy specimen showed subepidermal bullae with many amyloid deposits in the papillary dermis. No evidence of systemic amyloidosis could be found on physical examination. While the initial clinical diagnosis was bullous pemphigoid, the histopathology and direct immunofluorescence result favored hemodialysis-associated amyloidosis. However, immunochemical study for β2-microglobulin was negative. Further hematologic and immunologic work-up revealed the presence of multiple myeloma and that the deposit was AL amyloid. This is the first case of bullous amyloidosis in a hemodialysis patient and should remind dermatologists that bullous amyloidosis should be considered in addition to the usual presentation of porphyria cutanea tarda and pseudoporphyria for bullous dermatosis in the hemodialysis patient. We also suggest that hemodialysis-associated amyloidosis should not be taken for granted in the hemodialysis patient with cutaneous amyloidosis without systemic signs and symptoms. Further testing for other types of amyloid should be performed.

Original languageEnglish
Pages (from-to)153-156
Number of pages4
Issue number2
Publication statusPublished - 2007


  • Beta(β)2-microglobulin
  • Bullous amyloidosis
  • Bullous dermatosis
  • Hemodialysis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medicine(all)


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