Internal Medicine, Albany Medical Center, Albany, New York, USA
Pathology & Laboratory Medicine, Albany Medical Center, Albany, New York, USA.
BMJ Case Rep. 2021 Jun 24;14(6):e241505. doi: 10.1136/bcr-2020-241505.
We describe the case of a patient who presented with symptoms of persistent headaches, left-sided facial pain and blurry vision of the left eye. The patient had recovered from a herpes zoster infection of the V1 division of the trigeminal nerve 1 month prior. Serum inflammatory markers were elevated, raising concern for temporal arteritis. Empiric high-dose prednisone was initiated. Bilateral temporal artery biopsies were performed but did not show evidence of vasculitis or multinucleated giant cells. Instead, extracellular material deposits were present within the vessel walls. Congo red staining was diagnostic for amyloidosis. Liquid chromatography and mass spectrometry identified the amyloid fibrils to be transthyretin-type (ATTR) consistent with age-related amyloidosis. Temporal artery involvement of amyloidosis is rare but when present is most often due to light chain amyloidosis. Based on our review of the literature, only a few cases of temporal artery ATTR amyloidosis have been reported.
我们描述了一例患者，其表现为持续性头痛、左侧面部疼痛和左眼视力模糊。该患者在 1 个月前曾患有 V1 分支三叉神经带状疱疹感染。血清炎症标志物升高，引起对颞动脉炎的担忧。经验性给予大剂量泼尼松治疗。进行了双侧颞动脉活检，但未显示血管炎或多核巨细胞的证据。相反，血管壁内存在细胞外物质沉积。刚果红染色诊断为淀粉样变性。液相色谱和质谱分析鉴定出的淀粉样纤维为转甲状腺素蛋白型（ATTR），符合年龄相关性淀粉样变性。淀粉样变性累及颞动脉的情况很少见，但当发生时，通常是由于轻链淀粉样变性。根据我们对文献的回顾，仅报道了少数颞动脉 ATTR 淀粉样变性的病例。
