Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 3 3 2019 01 16 78 81 EN Morteza Daraei Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Goli Siri Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyed Farshad Allameh Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Masryam Lotfi Department of Pathology, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Samira Alesaeidi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran, Department of Rheumatology, Amir Alam Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2018 05 31 2018 10 16 We presented a middle-aged woman with nonspecifc signs and symptoms, including dyspnea, lower limb edema, and elevated jugular venous pressure. Among these, the skin changes including nail changes, macroglossia and periorbital rash were the mos important clues to suspect primary amyloidosis. Paraclinical sudies were anemia, proteinuria and resricted cardiomyopathy. Abdomi nal fat pad biopsy is usually the frs sep to confrm the amyloidosis. However, despite the negative hisologic result of fat-pad biopsy, we performed duodenal biopsy that confrmed amyloidosis. This case report demonsrates the important value of duodenal tissue in order to conform the diagnosis of amyloidosis. https://crcp.tums.ac.ir/index.php/crcp/article/view/201 https://crcp.tums.ac.ir/index.php/crcp/article/download/201/272