Doxycycline treatment in dialysis related amyloidosis: discrepancy between antalgic effect and inflammation, studied with FDG-positron emission tomography: a case report

BMC Nephrology

Case Report

Giorgina Barbara Piccoli¹  Jean Philippe Coindre²  Ida Molfino²  Charles Boursot³  Mammar Hachemi³ 

[1] Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy;Nephrologie, Centre Hospitalier du Mans, 198 Avenue Roubillard, 72000, Le Mans, France;Nephrologie, Centre Hospitalier du Mans, 198 Avenue Roubillard, 72000, Le Mans, France;Nuclear Medicine Centre Hospitalier Le Mans, 72000, Le Mans, France;

关键词: Dialysis related amyloidosis;    Hemodialysis;    Hemodiafiltration;    Long-term survival;    Positron emission tomography;    Doxycycline;   

DOI  :  10.1186/s12882-017-0698-z

 received in 2017-03-09, accepted in 2017-08-23,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundNo effective treatment is currently available and dialysis related amyloidosis continues to be invalidating in long-term dialysis patients. A recent case series reported reduction of osteoarticular pain on doxycycline treatment, extending the indications of this drug, used in other uncommon forms of amyloidosis, to dialysis patients. Explanations of the antalgic effect were the anti-inflammatory properties and anti-coiling effects of tetracycline.Case presentationOur report regards a 54-year-old woman, who was never transplanted and has been on hemodialysis and hemodiafiltration for overall 37 years, due to renal hypoplasia. In spite of high efficiency hemodiafiltration, she complained of increasing, invalidating osteoarticular pain; history and imaging suggested beta-2 microglobulin amyloid. Positron emission tomography (PET scan) identified metabolically active lesions in the involved settings. Low-dose doxycycline (100 mg/day) was started, leading to a considerable decrease in pain (over 6 months, from 7 to 8 to 4–5 on a 0–10 scale). At 6 months, a PET scan showed unmodified or increased uptake in the involved settings.ConclusionsIn summary, the previously described antalgic effect of doxycycline in dialysis related amyloidosis is confirmed in our case, the first studied using PET scan. The pattern at PET can suggests that the antalgic effect is independent from inflammation and points to other factors, such as interaction with fibril geometry or with bone structure.

【 授权许可】

CC BY   
© The Author(s). 2017