Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report

BMC Nephrology

Case Report

Naoki Oshima¹  Yuji Yamada¹  Akira Yamagata¹  Takahiro Uchida¹  Toshihiko Imakiire¹  Kazue Nagai¹  Hiroo Kumagai¹  Takashi Nakanishi² 

[1] Department of Nephrology and Endocrinology, National Defense Medical College, 3-2 Namiki, 359-8513, Tokorozawa, Saitama, Japan;Department of Rheumatology, National Defense Medical College, Tokorozawa, Saitama, Japan;

关键词: Amyloidosis;    Nephrotic syndrome;    Rheumatoid arthritis;    Tocilizumab;   

DOI  :  10.1186/s12882-017-0799-8

 received in 2016-10-31, accepted in 2017-12-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAmyloid A amyloidosis is one of the most common forms of amyloidosis. It is secondary to rheumatoid arthritis, which is difficult to manage and has a poor prognosis. We present a patient with rheumatoid arthritis and amyloid A amyloidosis who was treated with tocilizumab, a humanized monoclonal antibody against interleukin 6 receptor, resulting in improvement in both proteinuria and gastrointestinal symptoms; however, amyloid deposition remained.Case presentationA 67-year-old woman who had previously been treated for rheumatoid arthritis presented with abdominal pain and diarrhea. Right renal cell carcinoma was found, and amyloid A amyloidosis was diagnosed concomitantly based on colon biopsy. The renal cell carcinoma was resected, and the non-cancerous part of the renal tissue also showed amyloid A deposition. Following surgery, protein levels in the urine increased to the nephrotic range, and administration of tocilizumab was initiated, which resulted in resolution of the proteinuria. The patient’s gastrointestinal symptoms were also alleviated. However, repeat colon biopsy showed amyloid deposition.ConclusionsThis case of amyloid A amyloidosis suggests that amyloid deposition indicates only structural change of the affected tissue, and that it is not amyloid deposition per se that causes the clinical symptoms of amyloidosis.

【 授权许可】

CC BY   
© The Author(s). 2017