Raccoon Eye Caused by Dialysis-related Amyloidosis
Yuri Furuhashi, Tomotaka Takanosu, Masahiro Miki, Hiroko Kikuchi
Abstract
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TopicsAmyloidosis: Diagnosis, Treatment, Outcomes · Biomedical Research and Pathophysiology
A 64-year-old man undergoing hemodialysis for 17 years presented with periorbital ecchymosis without a history of head trauma (Figure 1). Laboratory tests and computed tomography showed no abnormalities, such as skull bone fractures. He has experienced a knee ligament injury and a trigger finger. Immunofixation electrophoresis detected no M-protein, and κ/λ ratio was within normal limits, thus immunoglobulin light-chain amyloidosis (AL amyloidosis) is excluded. Given his clinical manifestations, we clinically diagnosed dialysis-related amyloidosis (DRA). DRA is characterized by accumulation and tissue deposition of amyloid fibrils consisting of beta2-microglobulin in the bone, periarticular structures, and viscera. While periorbital purpura, or “raccoon eyes,” may appear in AL amyloidosis because of capillary fragility ^(1)^, cutaneous involvement in DRA is rare ^(2)^. Although biopsy is the gold standard for diagnosing DRA, it is rarely performed and is typically diagnosed clinically based on symptoms and imaging studies. Non-traumatic raccoon eyes can occur in dialysis patients, but it is essential to rule out AL amyloidosis.
Article Information
Conflicts of Interest
None
Author Contributions
Y.F. wrote the manuscript. M.M. participated in the examination. T.T. edited the manuscript. H.K. gave clinical advice. All authors have reviewed the draft of the manuscript.
Approval by Institutional Review Board (IRB)
IRB approval was not required in this study.
Informed Consent
We obtained informed consent from the patient to publish his details.
The reference list from the paper itself. Each links out to its DOI / PubMed record.
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