Purpose To describe a case of atypical systemic amyloidosis in a patient who p resented with recurrent subcutaneous bleeding of the eyelids and auricles. Desig n Observational case report. Methods A 52 year old man with chronic cardiac fa ilure, hypertension, weight loss, and impotence presentedwith recurrent bleeding of the eyelids and auricles, and was investigated for suspected amyloidosis. Re sults Biopsy specimens taken from the bone marrow, salivary gland, abdominal sub cutaneous fat, and gastric mucosa, and eyelidswere all negative forCongo red. Re sults of a conjunctival biopsy, which were returned after the patient’s death, and cardiac muscle autopsy were positive for Congo red staining, indicating amyl oidosis. Conclusion The findings in this case show that the presentation of amyl oidosis may be atypical. Ophthalmologists should consider a diagnosis of amyloid osis in patients with periorbital bleeding, even if biopsies are negative for Co ngo red. A conjunctival biopsy may be useful in establishing a diagnosis of prim ary systemic amyloidosis.
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