Histologic examination of sural nerve of a 32-year-old man with an aggressi
ve polyneuropathy associated with autonomic failure demonstrated amyloid de
position, and familial amyloidotic polyneuropathy (FAP) was diagnosed. Immu
nohistochemical staining showed transthyretin (TTR) staining of the amyloid
deposits in nerve. Sequencing revealed G to A transition in the codon 54 c
ausing TTR Lys 54. This is a new variant TTR associated with aggressive FAP
.