SHM Converge Scientific Abstract ePoster Gallery-Insulin Amyloidoma: The Importance of Recognition and Prevention

Pdf Summary

This case report describes a 63-year-old woman with insulin-dependent diabetes who developed a large, chronic, ulcerated abdominal nodule at a site repeatedly used for insulin injections over many years. The lesion gradually enlarged into an “insulin amyloidoma” and eventually ulcerated and became infected, prompting hospital transfer for surgical evaluation. Her history was notable for multiple comorbidities, including ESRD status post renal transplant, obesity, CAD, HTN, and immunosuppression.<br /><br />Imaging showed a superficial open wound with surrounding soft tissue inflammation in the pannus. Punch biopsy demonstrated amorphous pink globular dermal deposits with Congo red positivity and green birefringence under polarized light, confirming amyloidosis. Microbial stains were negative, though the patient also had a concurrent abscess. She was treated with broad-spectrum antibiotics and ultimately underwent surgical excision of the infected amyloidoma with primary closure, followed by oral antibiotics. She was counseled to rotate insulin injection sites to prevent recurrence.<br /><br />The report highlights that insulin-derived amyloidosis is often underdiagnosed or mistaken for other conditions such as infection, lipodystrophy, calciphylaxis, foreign body reaction, or malignancy. Repeated injections at the same site are the main risk factor, and impaired mobility or dexterity may contribute. The condition can worsen glycemic control because insulin is trapped within the amyloid mass, leading to unpredictable hypo- or hyperglycemia and inappropriate dose escalation. Diagnosis can be aided by ultrasound and confirmed with biopsy. The authors emphasize the importance of early recognition by hospitalists and patient education on injection-site rotation to prevent complications.

Asset Subtitle

Lois F. Richard

Meta Tag

Author List Lois F. Richard, Tanvir Rahman

Category Clinical Vignettes

Concept Insulin-derived Amyloidosis

Concept Injection Site Rotation

Concept Repeated Injection Site

Concept Congo Red Staining

Concept Apple-Green Birefringence

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis

Presenting Author Lois F. Richard

Track Adult

Keywords

insulin amyloidoma

insulin-derived amyloidosis

abdominal nodule

diabetes mellitus

Congo red staining

ulcerated lesion

injection site rotation

surgical excision

infected abscess

renal transplant

Insulin-derived Amyloidosis

Injection Site Rotation

Repeated Injection Site

Congo Red Staining

Apple-Green Birefringence