ATYPICAL BETA(2)-MICROGLOBULIN AMYLOIDOSIS FOLLOWING SHORT-TERM HEMODIALYSIS

A 47-year-old white female renal transplant recipient presented compla ining of ''wrinkles'' that predominantly involved the palmar aspect of her fingers. Light-microscopic examination of biopsy material obtaine d from affected areas revealed deposits of amorphous, hyaline material in the reticular dermis that contrasted sharply with collagen and ela stic fibers. Examination by transmission electron microscopy disclosed a mass of fibrils recognizable as amyloid, despite negative histochem ical staining with both Congo red and crystal violet. Immunoperoxidase staining for beta(2)-microglobulin was positive. Along with an elevat ed serum beta(2)-microglobulin level, this finding supported the diagn osis of hemodialysis-induced amyloidosis (HIA). Unusual features of ou r case include lesion location, short duration of antecedent hemodialy sis therapy, and negative staining for amyloid using conventional stai ning techniques.