Case and Research Letter
Secondary Amyloid Deposition in Discoid Lupus Erythematosus
Depósitos de amiloide secundarios a lupus eritematoso discoide
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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"apellidos" => "Arias-Santiago" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016000408" "doi" => "10.1016/j.adengl.2015.03.022" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000408?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015001507?idApp=UINPBA000044" "url" => "/00017310/0000010700000002/v2_201603080122/S0001731015001507/v2_201603080122/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Secondary Amyloid Deposition in Discoid Lupus Erythematosus" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "155" "paginaFinal" => "156" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Y. Hanami, T. Yamamoto" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "Hanami" ] 1 => array:4 [ "nombre" => "T." "apellidos" => "Yamamoto" "email" => array:1 [ 0 => "toyamade@fmu.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Depósitos de amiloide secundarios a lupus eritematoso discoide" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1280 "Ancho" => 1700 "Tamanyo" => 430456 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Multiple keratotic plaques scattered on the face. (B) Biopsy showed parakeratosis with focal hyperkeratosis, follicular plugging, liquefaction changes to the basal layers of the epidermis, and cellular infiltrates in the upper dermis (hematoxylin–eosin stain, original magnification 100×). (C) Dylon staining revealed amyloid deposition in the upper dermis (original magnification 200×). (D) The upper dermis was also positive for keratin (original magnification 200×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Secondary amyloid deposition is occasionally associated with skin tumors and inflammatory skin disorders, but it is rarely seen in discoid lupus erythematosus (DLE). We describe a case of secondary amyloid deposition in the lesional skin of DLE.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 47-year-old woman presented with keratotic erythema on the nose 3 years ago. The erythema had been present for 1 year and the histological features were compatible with DLE. Three years later, she revisited our hospital because the scaly erythematous patches had gradually increased in number. Physical examination revealed several reddish, well-circumscribed plaques with slightly elevated borders on the forehead, nose, cheeks, lip, and ear (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Laboratory data showed leukocytes within the normal range (8100<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">−3</span> with 32% neutrophils), normal liver and renal function, elevated immunoglobulin (Ig) G (2172<span class="elsevierStyleHsp" style=""></span>mg/dL), and positive titers of antinuclear antibody (1:1280), anti SS-A antibody (37.0<span class="elsevierStyleHsp" style=""></span>U/mL; normal, <7.0<span class="elsevierStyleHsp" style=""></span>U/mL), and anticentromere antibody (index of 34.4; normal, <10). Serum complement levels and antibodies against SS-B, ds-DNA, and Sm were all within normal limits. A second biopsy taken from a lesion on the dorsum of the nose showed parakeratosis, follicular plugging, liquefaction of the basal layer, and focal cellular infiltration in the dermis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). There was eosinophilic material in the upper dermis, which was positive with Congo red and Dylon staining (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) and anticytokeratin antibody 34βE12 staining (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The direct immunofluorescence study revealed IgM deposits at the dermal-epidermal junction, but no amyloid deposits were observed in another DLE specimen taken from the back of the ear. A detailed eye exam revealed decreased lacrimation, but saliva production measured by the Saxon test was normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Few papers have reported on secondary amyloid deposition in DLE, but it has been suggested that this phenomenon might be underreported.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Powell et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> reported 3 cases of DLE on the head and neck with amyloid deposition. They also retrospectively examined 18 cases of DLE, and detected amyloid deposition in 1 case. In a Japanese series, Khan et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> detected amyloid deposition in all 4 cases of hypertrophic DLE analyzed but in just 1 of 12 cases of nonhypertrophic DLE. They speculated that cutaneous amyloid material might have been deposited secondary to abnormalities in the basement membrane zone following repeated sunlight exposure for long periods. Our case was not hypertrophic-type DLE, but amyloid deposition was detected on the nose, which had an evident keratotic appearance. The fact that amyloid deposits were not detected in the DLE lesion on the back of the ear suggests that UV radiation may play a role in inducing basement membrane impairment, resulting in secondary amyloid deposition. The amyloid material also stained positively for 34βE12, suggesting that the origin of the amyloid was degenerating epidermal keratinocytes, which may be precursors of cutaneous amyloid. The presence of lamina densa-like substances or disturbed keratinization in the basal layers might also be involved in amyloid production.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Our patient also developed Sjögren syndrome, although she did not show any symptoms of dry mouth. Because systemic sclerosis was ruled out, the presence of serum anticentromere antibody was considered to be associated with Sjögren syndrome, although coexistence of this condition with DLE is rare.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Anticentromere antibody has been detected in 10% of Japanese patients with primary Sjögren syndrome<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>; these patients had lower mononuclear cell infiltration in the minor salivary glands, possibly explaining the lower frequency of dry mouth in this subgroup of patients. This hallmark symptom of Sjögren syndrome was also absent in our patient. In conclusion, there have been few reports on secondary amyloid deposition in DLE, but there may be more cases, especially in hyperkeratotic lesions in sun-exposed areas.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1280 "Ancho" => 1700 "Tamanyo" => 430456 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Multiple keratotic plaques scattered on the face. (B) Biopsy showed parakeratosis with focal hyperkeratosis, follicular plugging, liquefaction changes to the basal layers of the epidermis, and cellular infiltrates in the upper dermis (hematoxylin–eosin stain, original magnification 100×). (C) Dylon staining revealed amyloid deposition in the upper dermis (original magnification 200×). (D) The upper dermis was also positive for keratin (original magnification 200×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discoid lupus erythematosus with secondary amyloidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Powell" 1 => "S. Albert" 2 => "B. Bhogal" 3 => "M.M. 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Tani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10165-010-0352-0" "Revista" => array:6 [ "tituloSerie" => "Mod Rheumatol" "fecha" => "2011" "volumen" => "21" "paginaInicial" => "101" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20824298" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-centromere antibody-seropositive Sjögren's syndrome differs from conventional subgroup in clinical and pathological study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Nakamura" 1 => "A. Kawakami" 2 => "T. Hayashi" 3 => "N. Iwamoto" 4 => "A. Okada" 5 => "M. Tamai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2474-11-140" "Revista" => array:5 [ "tituloSerie" => "BMC Musculoskelet Disord" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20591195" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000010700000002/v2_201603080122/S0001731015003427/v2_201603080122/en/main.assets" "Apartado" => array:4 [ "identificador" => "48560" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000010700000002/v2_201603080122/S0001731015003427/v2_201603080122/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003427?idApp=UINPBA000044" ]
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| 2022 Abril | 34 | 37 | 71 |
| 2022 Marzo | 28 | 51 | 79 |
| 2022 Febrero | 27 | 26 | 53 |
| 2022 Enero | 29 | 41 | 70 |
| 2021 Diciembre | 19 | 32 | 51 |
| 2021 Noviembre | 30 | 43 | 73 |
| 2021 Octubre | 30 | 48 | 78 |
| 2021 Septiembre | 28 | 37 | 65 |
| 2021 Agosto | 22 | 28 | 50 |
| 2021 Julio | 20 | 36 | 56 |
| 2021 Junio | 26 | 43 | 69 |
| 2021 Mayo | 40 | 23 | 63 |
| 2021 Abril | 101 | 35 | 136 |
| 2021 Marzo | 63 | 21 | 84 |
| 2021 Febrero | 49 | 33 | 82 |
| 2021 Enero | 25 | 16 | 41 |
| 2020 Diciembre | 37 | 12 | 49 |
| 2020 Noviembre | 15 | 20 | 35 |
| 2020 Octubre | 21 | 20 | 41 |
| 2020 Septiembre | 19 | 7 | 26 |
| 2020 Agosto | 20 | 18 | 38 |
| 2020 Julio | 25 | 11 | 36 |
| 2020 Junio | 32 | 25 | 57 |
| 2020 Mayo | 24 | 22 | 46 |
| 2020 Abril | 32 | 28 | 60 |
| 2020 Marzo | 29 | 25 | 54 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 8 | 0 | 8 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 6 | 6 | 12 |
| 2019 Mayo | 4 | 25 | 29 |
| 2019 Abril | 2 | 3 | 5 |
| 2019 Marzo | 2 | 5 | 7 |
| 2019 Febrero | 2 | 2 | 4 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 3 | 4 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 1 | 2 | 3 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Mayo | 1 | 0 | 1 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Febrero | 8 | 2 | 10 |
| 2018 Enero | 40 | 5 | 45 |
| 2017 Diciembre | 10 | 5 | 15 |
| 2017 Noviembre | 9 | 4 | 13 |
| 2017 Octubre | 5 | 6 | 11 |
| 2017 Septiembre | 9 | 9 | 18 |
| 2017 Agosto | 10 | 5 | 15 |
| 2017 Julio | 5 | 6 | 11 |
| 2017 Junio | 11 | 30 | 41 |
| 2017 Mayo | 5 | 12 | 17 |
| 2017 Abril | 8 | 7 | 15 |
| 2017 Marzo | 5 | 63 | 68 |
| 2017 Febrero | 7 | 8 | 15 |
| 2017 Enero | 6 | 4 | 10 |
| 2016 Diciembre | 7 | 10 | 17 |
| 2016 Noviembre | 13 | 11 | 24 |
| 2016 Octubre | 9 | 20 | 29 |
| 2016 Septiembre | 0 | 4 | 4 |
| 2016 Agosto | 1 | 2 | 3 |
| 2016 Julio | 1 | 2 | 3 |
| 2016 Junio | 1 | 2 | 3 |
| 2016 Abril | 0 | 1 | 1 |
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