{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T04:04:08Z","timestamp":1767585848831,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,21]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>A 69-year-old woman presented with an 18-month history of recurrent bruising of the eyelids. She was otherwise asymptomatic and systems review was unremarkable. On examination, she had peri-orbital purpura and waxy papules at the inner canthus of both eyes. Macroglossia was also noted. Subcutaneous abdominal biopsy identified amorphous material in the dermis that stained positive for Congo red, with apple-green birefringence seen under polarised microscopy. Immunohistochemistry demonstrated antibodies against lambda light chains. Bone marrow biopsy identified further deposits of immunoglobulin light chain amyloid and a clonal infiltrate with 10%\u201320%\u2009plasma cells, confirming amyloidosis secondary to multiple myeloma. Iodine-123-labelled serum amyloid protein scintigraphy showed no abnormal uptake, thereby excluding significant amyloid deposits in the liver, spleen or kidneys. Cardiac MRI was consistent with early amyloid infiltration. We highlight the importance of dermatological manifestations in amyloidosis, to allow for early diagnosis, potentially limiting end organ involvement.<\/jats:p>","DOI":"10.1136\/bcr-2020-239478","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T13:21:55Z","timestamp":1617283315000},"page":"e239478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Spontaneous bilateral peri-orbital purpura: an important clinical sign of primary systemic amyloidosis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7832-406X","authenticated-orcid":false,"given":"Paula Evelyn","family":"Beatty","sequence":"first","affiliation":[{"name":"Department of Dermatology, Tallaght University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0269-681X","authenticated-orcid":false,"given":"Lisa","family":"Killion","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Tallaght University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johnny","family":"Mc Hugh","sequence":"additional","affiliation":[{"name":"Department of Haematology, Tallaght University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Marie","family":"Tobin","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Tallaght University Hospital, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,1]]},"reference":[{"key":"2025082722511834000_14.4.e239478.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(88)70001-8"},{"key":"2025082722511834000_14.4.e239478.2","unstructured":"Groves R , Black M . Amyloidosis. In: Bolognia JL , Jorizzo JL , Schaffer JV , eds. Dermatology. 2. Elsevier Saunders, 2012."},{"key":"2025082722511834000_14.4.e239478.3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.38.5724"},{"key":"2025082722511834000_14.4.e239478.4","doi-asserted-by":"crossref","first-page":"2641","DOI":"10.1016\/S0140-6736(15)01274-X","article-title":"Systemic amyloidosis","volume":"387","author":"Wechalekar","year":"2016","journal-title":"The Lancet"},{"key":"2025082722511834000_14.4.e239478.5","unstructured":"Amyloidosis.org . Amyloidosis patient information site. Available: https:\/\/www.amyloidosis.org.uk\/about-amyloidosis\/al-amyloidosis\/understanding-al-amyloidosis\/ [Accessed 10 Sep 2020]."},{"key":"2025082722511834000_14.4.e239478.6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.krcp.2016.05.001","article-title":"Bullous skin lesions in a patient with end-stage renal disease combined with myeloma and primary amyloidosis","volume":"35","author":"Jung","year":"2016","journal-title":"Kidney Res Clin Pract"},{"key":"2025082722511834000_14.4.e239478.7","doi-asserted-by":"crossref","DOI":"10.1186\/2162-3619-1-19","article-title":"Response of hemorrhagic bullous skin lesions of the breast secondary to primary systemic amyloidosis to a five-drug combination chemotherapy: a case report and review of the literature","volume":"1","author":"Agheli","year":"2012","journal-title":"Exp Hematol Oncol"},{"key":"2025082722511834000_14.4.e239478.8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1590\/abd1806-4841.20132531","article-title":"Primary systemic amyloidosis, acquired cutis laxa and cutaneous mucinosis in a patient with multiple myeloma","volume":"88","author":"Lavorato","year":"2013","journal-title":"An Bras Dermatol"},{"key":"2025082722511834000_14.4.e239478.9","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2018-135855"},{"key":"2025082722511834000_14.4.e239478.10","doi-asserted-by":"crossref","DOI":"10.1182\/blood.V122.21.1900.1900","article-title":"Proteome of amyloidosis: Mayo clinic experience in 4139 cases","volume":"122","author":"Theis","year":"2013","journal-title":"Blood"},{"key":"2025082722511834000_14.4.e239478.11","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.cpcardiol.2017.04.003","article-title":"Cardiac amyloidosis: an updated review with emphasis on diagnosis and future directions","volume":"43","author":"Bhogal","year":"2018","journal-title":"Curr Probl Cardiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239478","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:51:29Z","timestamp":1756360289000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,1]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2020-239478"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239478","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}