Severe Destructive Tendinopathy in the Wrist Due to Dialysis-Related Amyloidosis

Abstract

Dialysis-related amyloidosis (DRA) is a specific subtype of amyloidosis with several clinical presentations. Herein we report a case of severe destructive tendinopathy around the wrist associated with long-standing hemodialysis (HD). A 63-year-old female patient who had been on regular HD for 23 years suffered from symptoms of pain and a palpable mass around the wrist. Magnetic resonance imaging showed an ill-defined soft tissue mass around the extensor tendons that partially invaded the wrist joint. We performed surgical excision and tenolysis for the mass. The operative finding revealed an ill-defined yellowish soft tissue mass extensively invading the extensor tendons and wrist joint. The tendon fibers were severely fibrillated and showed impending rupture due to the infiltrated mass. Histological examination showed DRA. Amyloidosis-induced tendinopathy should be considered when a patient on long-term HD complains of an unusual mass-like lesion in the extremity and/or nonspecific joint stiffness. Early surgical intervention improves patient's disability and decreases the risk of spontaneous tendon rupture.