Using Muscle

A biopsy of the left medial rectus was performed and tissue cultures were sent. Initial histopathology was inconclusive at our institution. Consultation with Dr. Chevz-Barrios at Houston Methodist Hospital established a diagnosis of amyloidosis. The figure includes the following: a. Routine stain showing entrapped striated muscle fibers in an amorphous amphophilic material suggestive of amyloid (H&E, 20X original magnification). b. Adjacent field shows amorphous material in the wall of a vessel. This field is the same as c-e. (H&E, 10X original magnification). c. Congo red stain for amyloid shows positive red staining of the amorphous material (Congo red stain, 10X original magnification). d and e. Congo red under polarization demonstrating the dichroisms of orange to apple green (Congo red stain under polarization, 10X original magnification). Pulmonary function testing was normal. A CT of chest, abdomen and pelvis was performed and was normal. Cardiology and Hematology-oncology consultations were unrevealing with a normal echocardiogram and normal bone marrow biopsy. Amyloidosis is a rare disorder that can be associated with chronic inflammation such as tuberculosis or that may be primary. The quantiferon gold test was positive but there was no cultural or pathologic evidence of tuberculosis in the biopsy specimen and imaging of the entire body did not reveal any suspicious areas in the lungs or elsewhere.