Hamidou M, Buzelin F, Rojouan J, Barrier J H, Briseau J M, Grolleau J Y
Service de Médecine Interne, Hôtel Dieu, Nantes.
Rev Med Interne. 1991 Jul-Aug;12(4):306-8. doi: 10.1016/s0248-8663(05)82870-x.
The authors report a case of amyloidosis AL associated with light lambda chain myeloma, mimicking giant cell temporal arteritis. The normality of inflammatory proteins, the primary resistance to corcicosteroids and the results of temporal artery biopsy (amyloid deposits without giant cell granuloma) excluded a diagnosis of giant cell arteritis associated with amyloidosis. The most probable mechanism was infiltration of branches of the external carotid artery. In patients with temporal arteritis, amyloidosis must be suspected and sought, particularly in case of monoclonal dysglobulinaemia or manifestations that are not typical of giant cell temporal arteritis. The prognosis of vascular amyloidosis seems to be more favourable than that of the classical visceral types. The primary amyloidosis of these patients must be treated with melphalan combined with prednisone and colchicine.
作者报告了一例与轻链λ型骨髓瘤相关的AL型淀粉样变性病例，该病例酷似巨细胞颞动脉炎。炎症蛋白正常、对皮质类固醇的原发性抵抗以及颞动脉活检结果（淀粉样沉积无巨细胞肉芽肿）排除了与淀粉样变性相关的巨细胞动脉炎的诊断。最可能的机制是颈外动脉分支的浸润。在患有颞动脉炎的患者中，必须怀疑并寻找淀粉样变性，特别是在存在单克隆球蛋白血症或非典型巨细胞颞动脉炎表现的情况下。血管淀粉样变性的预后似乎比经典内脏型更有利。这些患者的原发性淀粉样变性必须用美法仑联合泼尼松和秋水仙碱治疗。
