Matsumoto K, Kikuchi J, Kaneko Y, Yasuoka H, Suzuki K, Tokuyama H, Kameyama K, Yamaoka K, Takeuchi T. Persistent fever and destructive arthritis caused by dialysis-related amyloidosis: A case report.
Medicine (Baltimore) 2018;
97:e9359. [PMID:
29505515 PMCID:
PMC5943088 DOI:
10.1097/md.0000000000009359]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE
Dialysis-related amyloidosis (DRA) can present rheumatic manifestations in patients on long-term hemodialysis. Typical articular symptoms with DRA involve carpal-tunnel syndrome, effusion in large joints, spondyloarthropathy, or cystic bone lesions, which are usually with non-inflammatory processes.
PATIENT CONCERNS
A 64-year-old man on hemodialysis for >30 years was admitted because of intermittent fever, polyarthritis, and elevated serum C-reactive protein (CRP) level, which was continuous for 2 years. Several antibiotics were ineffective for 3 months before his admission. On physical examination, joint swelling was observed at bilateral wrists, knees, ankles, and hip joints. Laboratory tests revealed elevation of serum inflammatory markers and β2-microglobulin (β2-MG). Synovial fluid showed predominant infiltration of polymorphonuclear leukocytes and the increase of β2-MG level.
DIAGNOSIS
Significant deposition of β2-MG with inflammatory cell infiltration was found in biopsied samples from synovium, skin, and ileum.
INTERVENTIONS
We decided to switch to the hemodialysis column with membrane that can effectively absorb β2-MG in circulation.
OUTCOMES
The relief of symptoms and a decrease of CRP level by changing the membrane lead to the final diagnosis of DRA.
LESSONS
Our case demonstrates that DRA arthropathy can be inflammatory and destructive, and also develop systemic inflammatory signs and symptoms. In such cases, aggressive absorption of β2-MG in circulation might help the amelioration of symptoms.
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