Question 106

Question:

A 76 year-old woman with a long history of rheumatoid arthritis presents complaining of weakness and swelling of her hands and feet. On exam, BP is 140/78, HR is 76, and RR is 12. There is mild hepatomegaly. Urinalysis shows proteinuria and liver function tests are mildly abnormal. Congo red stain of liver biopsy shows apple green birefringence when viewed under polarized light. Accumulation of which protein accounts for this finding?

Correct Answer: A.  Amyloid Associated protein

This patient has secondary amyloidosis due to long-standing rheumatoid arthritis, which results in accumulation of AA protein. Other causes of secondary amyloidosis include tuberculosis, osteomyelitis, and syphilis. AL protein is seen in primary amyloidosis. Transthyretin is seen in senile amyloidosis. Amylin is seen in amyloidosis secondary to type II diabetes mellitus.