Toxicity of insulin-derived amyloidosis: a case report
2019
Insulin-derived
amyloidosisis a skin-related complication of insulin therapy that interferes with insulin therapy. Although
toxicitiesof in vitro-formed insulin
amyloidfibrils have been well studied, the
toxicityof insulin-derived
amyloidosisremains to be clarified. A 58-year-old man with type 2 diabetes mellitus underwent a
lower limb amputationdue to diabetic
gangrene. Several antibiotics including
minocyclinewere administered for infection and sepsis. A hard mass at the insulin injection sites in the lower abdomen was discovered by chance four months later. Although no abnormal findings in the surface skin of the mass were observed, necrotic tissue was seen around the mass when a biopsy was performed. Histological and
toxicitystudies were performed for this patient and four other patients with
abdominal massesat insulin injection sites. Histological and immunohistochemical studies showed that the masses had typical characteristics of
amyloiddeposits in all cases, whereas necrotic findings were seen adjacent to the
amyloiddeposit only in the case presented.
Toxicitystudies indicated that the
amyloidtissue from the present case had significant cell
toxicitycompared to the control skin tissue or the
amyloidtissues from the other four cases. This report showed that
toxicinsulin-derived
amyloidosiscan occur. In addition, this report suggested that
toxicinsulin-derived
amyloidosismay cause necrosis in the surrounding tissue. Although the
toxic
amyloiddeposit of insulin-derived
amyloidosiswas found in only one patient, no structural differences between
toxicand non-
toxicdeposits were seen on histological and immunohistochemical studies.
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