Amyloid lymphadenopathy: an uncommon means of diagnosing systemic amyloidosis.

Introduction.-It is uncommon that lymph node enlargement is diagnostic of s ystemic amyloidosis as found in the case reported in this study. Exegesis.-This study examined the case of a 49-year old male with chronic b ronchitis in whom in 1990 the presence had ben detected of an isolated cerv ical lymphadenopathy, 2 cm in diameter, and which had previously remained u nnoticed. In 1993, a significant number of other peripheral adenopathies al so appeared in various locations, i.e., cervical, axillary, inguinal. Chest and abdominal CT-scans revealed several mediastinal and abdominal lymphade nopathies. The histological study with Congo red stain of a cervical lymph node biopsy determined the diagnosis of amyloidosis. The patient was at tha t time asymptomatic. In September 1997, upon physical examination the follo wing were found: lower limb edema, superior vena cava syndrome, and several cervical lymphadenopathies. Abdominal ultrasonography showed enlarged kidn eys, and homogeneous splenomegaly. Biological examination determined the ex istence of a nephrotic syndrome with renal failure and creatinemia of 350 m u mol/L. Due to superior vena cava syndrome worsening, cervical lymph node removal was performed. However, the patient died after rapid renal failure. Conclusion.-Although it is a rare occurrence, amyloidosis should be taken i nto consideration in the differential diagnosis of isolated lymphadenopathy . Congo red stain amongst others, and an immunohistochemical study should b e performed in cases of uncertain diagnosis. (C) 1999 Editions scientifique s et medicales Elsevier SAS.