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

BACKGROUND: Amyloid 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 mon...

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Autores principales: Yamagata, Akira, Uchida, Takahiro, Yamada, Yuji, Nakanishi, Takashi, Nagai, Kazue, Imakiire, Toshihiko, Oshima, Naoki, Kumagai, Hiroo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747944/
https://www.ncbi.nlm.nih.gov/pubmed/29287589
http://dx.doi.org/10.1186/s12882-017-0799-8
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author Yamagata, Akira
Uchida, Takahiro
Yamada, Yuji
Nakanishi, Takashi
Nagai, Kazue
Imakiire, Toshihiko
Oshima, Naoki
Kumagai, Hiroo
author_facet Yamagata, Akira
Uchida, Takahiro
Yamada, Yuji
Nakanishi, Takashi
Nagai, Kazue
Imakiire, Toshihiko
Oshima, Naoki
Kumagai, Hiroo
author_sort Yamagata, Akira
collection PubMed
description BACKGROUND: Amyloid 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 PRESENTATION: A 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. CONCLUSIONS: This 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.
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spelling pubmed-57479442018-01-03 Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report Yamagata, Akira Uchida, Takahiro Yamada, Yuji Nakanishi, Takashi Nagai, Kazue Imakiire, Toshihiko Oshima, Naoki Kumagai, Hiroo BMC Nephrol Case Report BACKGROUND: Amyloid 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 PRESENTATION: A 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. CONCLUSIONS: This 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. BioMed Central 2017-12-29 /pmc/articles/PMC5747944/ /pubmed/29287589 http://dx.doi.org/10.1186/s12882-017-0799-8 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Yamagata, Akira
Uchida, Takahiro
Yamada, Yuji
Nakanishi, Takashi
Nagai, Kazue
Imakiire, Toshihiko
Oshima, Naoki
Kumagai, Hiroo
Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
title Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
title_full Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
title_fullStr Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
title_full_unstemmed Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
title_short Rapid clinical improvement of amyloid A amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
title_sort rapid clinical improvement of amyloid a amyloidosis following treatment with tocilizumab despite persisting amyloid deposition: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747944/
https://www.ncbi.nlm.nih.gov/pubmed/29287589
http://dx.doi.org/10.1186/s12882-017-0799-8
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