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Case Reports
. 2023 Apr 6:10:1064832.
doi: 10.3389/fmed.2023.1064832. eCollection 2023.

Insulin amyloidosis: A case report

Arthur Dubernet  1 , Maud Toulmonde  2 , Magali Colombat  3 , Cécile Hartog  4 , Etienne Riviere  1   5
Affiliations
Case Reports

Insulin amyloidosis: A case report

Arthur Dubernet et al. Front Med (Lausanne). .

Abstract

Insulin amyloidosis is a rare form of localized amyloidosis due to insulin aggregation into subcutaneous amyloid fibrils. We describe the case of a 55 years old male with insulin-requiring type 1 diabetes presenting with two non-inflammatory intra-dermal nodules associated with local lymph node enlargement. Diagnosis was confirmed by Congo red coloration of the amyloid deposit and insulin protein identification on mass spectrometry. Insulin amyloidosis is a potential complication of repeated subcutaneous insulin injections. The main risk factor is the intrinsic characteristic of the insulin used. Insulin amyloidosis leads to systemic metabolic consequences such as chronic hyperglycemia or unpredictable hypoglycemia, as well as unesthetic cutaneous lumps or abscesses. Standard-of-care is yet to be defined but mainly rely on therapeutical education of insulin injections, while surgical excision is reported to improve glycemic control in some patients.

Keywords: amyloidosis; case report; hyperglycemia; insulin; type 1 diabetes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

Figures

Figure 1
Figure 1
Clinical and paraclinical features of the patient. (A) Presence of two subcutaneous nodules on the left arm (arrows), (B) Soft tissue ultrasound of the left arm evidencing and measuring one subcutaneous mass, (C) MRI frontal slices of the left upper limb (T1 with gadolinium injection on the left, and T2 on the right), and (D) 18-FDG-PET-CT scan showing a 18-FDG uptake by the nodule (arrow) on the left arm.
Figure 2
Figure 2
Histological analyses of the biopsy of one subcutaneous nodule. (A) HES section at low magnification (x10) evidencing granulomas with giant cells (arrows) phagocytizing the amorphous substance (*), (B) HES section at higher magnification (x40), (C) Section at low magnification (x4) stained with Congo Red evidencing the amyloid deposit (*), and (D) Detailed results of the mass spectrometry evidencing the insulin protein highlighted in yellow, along with the serum amyloid P-component in red (of note, immunoglobulin heavy gamma chains were of polyclonal origin).
See this image and copyright information in PMC

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