Persistent fever and destructive arthritis caused by dialysis-related amyloidosis: A case report. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Matsumoto, Kotaro; Kikuchi, Jun; Kaneko, Yuko; Yasuoka, Hidekata; Suzuki, Kazuko; Tokuyama, Hirobumi; Kameyama, Kaori; Yamaoka, Kunihiro; Takeuchi, Tsutomu
• Other Names: Pavlos. Malindretos section editor.
• Is Part Of: Medicine. Volume 97:Issue 1(2018)
• Publication Date: 2018-01
• Subjects: β2-microglobulin -- β2-microglobulin modified by advanced glycation end products -- dialysis-related amyloidosis -- fever of unknown origin -- long-term hemodialysis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000009359
• Languages: English
• ISSNs: 0025-7974

Abstract

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.