Hepatic alect-2 amyloidosis causing portal hypertension and recurrent variceal bleeding

Abstract

Objectives: To examine laser microdissection and mass spectrometry (LMD-MS), which has emerged as a new tool to aid in typing amyloid proteins. Results: ALECT-2 is a potential cause of hepatic amyloidosis best detected by LMD-MS. Methods: One of the more recently reported proteins is ALECT-2 (leukocyte cell-derived chemotaxin 2) amyloid, found in renal specimens of Hispanic patients. Here we report the first case of hepatic ALECT-2 amyloidosis diagnosed by LMD-MS from a liver biopsy specimen of a 52 year-old Hispanic man and causing portal hypertension with recurrent esophageal variceal bleeding. Conclusions: ALECT-2 can cause amyloidosis in organs other than the kidneys. It should be strongly considered in Hispanic patients and in those with a globular pattern of amyloid deposition. The incidence of ALECT-2 amyloidosis is likely underreported.