Disclosures: Eduardo Carrera, MD: No financial relationships or conflicts of interest

Case Description: The patient was referred to clinic with 2 months of insidious axial neck and posterior shoulder pain having failed a course of physical therapy and medication management. Physical exam was neurovascularly intact with exception of stable severe diabetic polyneuropathy and there were no signs/symptoms of infection. Magnetic resonance imaging of the cervical spine was performed with severe focal C6-7 disc degeneration and questionable discitis. This prompted further workup including CBC, blood cultures, CRP, sedimentation rate, and cervical CT.

Setting: Tertiary academic outpatient spine/pain clinic

Patient: 53yo M poorly adherent type 2 diabetic with end stage renal disease on hemodialysis Assessment/

Results: Lab testing lacked any further evidence for infection but again demonstrated significant destruction of the C6-7 disc space extending cephalad into C6 and distal to C7 with a soft tissue mass that extended posteriorly with mass effect on the central canal. Tissue biopsy was negative for infectious process and suggested a diagnosis of Amyloid Arthropathy. Patient was optimized on medical management and has not undergone interventional or surgical intervention.

Discussion: Amyloid Arthropathy is a rare disorder that is predominantly seen in patients requiring prolonged hemodialysis. It is thought to occur as a consequence of β2-microglobulin deposition resulting in destructive osteoarthropathies, typically of the shoulder or carpal region (often manifesting as carpal tunnel syndrome), but can present in the axial skeleton mimicking the appearance of an infectious or malignant process.

Conclusion: A diagnosis of spinal amyloid arthropathy should be considered in patients on chronic hemodialysis with erosive spondyloarthropathies without evidence of discitis/osteomyelitis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/osteolytic-cervical-amyloid-arthropathy-in-a-chronically-hemodialyzed-patient-a-case-study/