Fatal cervical spondyloarthropathy in a hemodialysis patient with systemic deposition of β2-microglobulin amyloid

Destructive spondyloarthropathy is a serious complication in patients with end-stage renal disease, We report a case of fatal cervical spondyloarthropathy in a patient on hemodialysis who presented with severe pain in the cervical area. Magnetic resonance imaging (MRI) of the cervical spine showed a soft tissue mass at the cervico-occipital hinge with spinal cord compression and destructive lesions of the cervical vertebrae, The patient became quadriplegic during the MRI procedure and died a few days later. Postmortem examination showed deposition of beta(2)-microglobulin in the cervico-occipital hinge, A unique feature of this case was the documented presence of systemic beta(2)-microglobulin amyloid deposits involving the spleen that to our knowledge has not been reported previously. Clinical suspicion end early detection of lesions caused by dialysis-related amyloidosis (DRA) may help to prevent significant morbidity and mortality in long-term dialysis patients. (C) 1999 by the National Kidney Foundation, Inc.