Subject(s)
Anticonvulsants/adverse effects , Antimetabolites, Antineoplastic/pharmacology , Leucovorin/pharmacology , Phenytoin/adverse effects , Tegafur/pharmacology , Administration, Oral , Anticonvulsants/therapeutic use , Antimetabolites, Antineoplastic/therapeutic use , Carcinoma/drug therapy , Drug Interactions , Epilepsy/drug therapy , Humans , Leucovorin/therapeutic use , Male , Middle Aged , Phenytoin/therapeutic use , Rectal Neoplasms/drug therapy , Tegafur/therapeutic useABSTRACT
Amyloidosis typically manifests with disseminated infiltration of multiple organ systems. Rarely, amyloidosis may be localized. We report a patient with localized subcutaneous nodular amyloidosis, without systemic amyloid involvement or myeloma, whose presenting symptom was multiple discrete neck nodules. Immunohistochemical analysis showed the amyloid deposits to be derived from lambda light chains. Twenty-four month follow-up showed minimal disease progression. A literature review showed only 5 reported cases of subcutaneous nodular amyloidosis. This is the first description of a patient with subcutaneous nodular amyloidosis derived from lambda light chains. HUM PATHOL 32:346-348.
Subject(s)
Amyloidosis/diagnosis , Neck , Adult , Amyloid/analysis , Amyloidosis/metabolism , Amyloidosis/pathology , Antibodies, Monoclonal , Bence Jones Protein/urine , Biopsy , Female , Humans , Immunoglobulin M/blood , Immunoglobulin lambda-Chains/blood , Immunohistochemistry , Male , Middle Aged , Muscle, Skeletal/pathology , Proteinuria/urine , Tomography, X-Ray ComputedABSTRACT
Many rheumatic diseases affect women of childbearing age, and the medications used to treat these diseases may affect conception, pregnancy, fetal development, and lactation. Physicians who care for these women need to be aware of the potential adverse effects of these medications, and which medications can be used safely prior to conception and during pregnancy and lactation. Although reviews of individual classes of medications are available, there is no practical and comprehensive review that summarizes all of this information, and includes anticoagulant drugs and 2 recently approved drugs for rheumatoid arthritis. Women who take cytotoxic drugs should be informed of the risks of impaired fertility and congenital malformations, and must use effective methods of contraception. During pregnancy, nonsteroidal anti-inflammatory agents may be used until the last 6 weeks, and low to moderate doses of corticosteroids are safe throughout pregnancy. Among the disease-modifying agents, sulfasalazine and hydroxychloroquine treatment may be maintained. Cytotoxic drugs may be used after the first trimester to treat life-threatening disease. During lactation, prednisone, sulfasalazine, and hydroxychloroquine may be used cautiously. Women using heparin for treatment of antiphospholipid antibody syndrome should take measures to prevent bone loss. Men taking methotrexate, sulfasalazine, cyclosporine, azathioprine, or leflunomide should be apprised of the possibilities of infertility and teratogenicity.
