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A 60-year old man presented on 24/12/2016 with tingling, burning sensation and numbness in the hands and feet, progressive muscle weakness and wasting for 1 year; dryness, thickening, darkening and fissuring of skin over all body for 6 months. Patient also had complained generalized aches and pains and occasional low grade fever. He did not have Diabetes or Hypertension. In spite of receiving calcium and vitamin supplements, there was no improvement. Examination revealed an ill looking but cooperative elderly man with mild anaemia, tenderness over sternum and other bony areas, hyper pigmented, thick velvety, fissured skin all over body ,there was no peri orbital purpura. Muscles of hand, forearm, feet, and leg were wasted with reduced muscle power and tone. Ankle jerks were absent bilaterally and all sensory modalities were impaired in the distal part of limbs. Investigations showed a persistently elevated ESR over 100 mm of Hg , normocytic anaemia VELVETY, HYPER PIGMENTED AND FISSURED SKIN: MULTIPLE MYELOMA-ASSOCIATED SKIN LIGHT CHAIN AMYLOIDOSIS

Velvety, hyper pigmented and fissured skin: Multiple myeloma-associated skin light chain amyloidosis