Article Text

Download PDFPDF
Case report
Severe hand pain as an extracardiac manifestation of transthyretin amyloidosis
  1. Sneha N Patel1,
  2. Sai Krishna Koyoda2,
  3. Daniel Schwartz3 and
  4. Bibi Ayesha1
  1. 1 Rheumatology, Montefiore Hospital and Medical Center, Bronx, New York, USA
  2. 2 Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
  3. 3 Pathology, Montefiore Hospital and Medical Center, Bronx, New York, USA
  1. Correspondence to Dr Sneha N Patel; snehap721{at}


Transthyretin amyloidosis is a multisystemic disease caused by the aggregation of amyloid fibrils, resulting in high morbidity and mortality in the presence of cardiac involvement. Patients often experience vague symptoms that make amyloidosis difficult to diagnose. Differential diagnosis for hand pain in a patient with systemic amyloidosis is broad. We present a patient with severe hand cramping and inability to perform activities of daily living. This preceded a new diagnosis of familial amyloid cardiomyopathy. The patient was a poor responder to systemic corticosteroids, anti-inflammatories and anticonvulsant therapy. Her unique presentation gives insight into a rare but debilitating disorder and the potential link between amyloidosis and other disease processes.

  • rheumatology
  • heart failure
  • arrhythmias
  • musculoskeletal syndromes
  • peripheral nerve disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors SNP provided substantial contributions to the conception and design of the work, the acquisition and analysis of data, and drafting the final piece. SKK assisted in drafting the initial discussion. DS provided relevant images and descriptions. BA revised the work and, along with SNP, gave the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.