Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis
Systemic reactive AA amyloidosis is a life-threatening complication of chronic inflammatory diseases. Anti-interleukin-6 receptor, tocilizumab (TCZ), has been shown to improve clinical symptoms of patients with AA amyloidosis, accompanied with regression of the amyloid deposition. We report a case o...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2014/823093 |
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| author | Masaru Matsui Satoshi Okayama Hideo Tsushima Kenichi Samejima Tomoko Kanki Ayako Hasegawa Katsuhiko Morimoto Yasuhiro Akai Masato Takano Shiro Uemura Chiho Ohbayashi Yoshihiko Saito |
| author_facet | Masaru Matsui Satoshi Okayama Hideo Tsushima Kenichi Samejima Tomoko Kanki Ayako Hasegawa Katsuhiko Morimoto Yasuhiro Akai Masato Takano Shiro Uemura Chiho Ohbayashi Yoshihiko Saito |
| author_sort | Masaru Matsui |
| collection | DOAJ |
| description | Systemic reactive AA amyloidosis is a life-threatening complication of chronic inflammatory diseases. Anti-interleukin-6 receptor, tocilizumab (TCZ), has been shown to improve clinical symptoms of patients with AA amyloidosis, accompanied with regression of the amyloid deposition. We report a case of AA amyloidosis evaluated by histology of multiple organs before and after TCZ treatment. A woman in her 60s with rheumatoid arthritis was referred to our hospital because of cardiac and renal dysfunction. A gastric and renal biopsy revealed the deposition of AA amyloid, and echocardiography revealed concentric left ventricular hypertrophy. Her estimated glomerular filtration rate was decreased to 8.6 mL/min/1.73 m2, and B-type natriuretic peptide, C-reactive protein, and serum amyloid A protein were significantly elevated. TCZ treatments markedly decreased her serum amyloid A protein and C-reactive protein levels, but hemodialysis was required 1 year later. Endoscopic gastric rebiopsy 3 years after initiation of TCZ treatments revealed the regression of amyloid deposition and echocardiography revealed improvement of her left ventricular hypertrophy. However, a renal rebiopsy revealed that the amyloid deposition had not regressed. In conclusion, these observations suggest that the therapeutic effects of TCZ can vary among organs in patients with AA amyloidosis. |
| format | Article |
| id | doaj-art-c394491fd2564bf2a45dc3b1d9179399 |
| institution | OA Journals |
| issn | 2090-6641 2090-665X |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Nephrology |
| spelling | doaj-art-c394491fd2564bf2a45dc3b1d91793992025-08-20T02:18:55ZengWileyCase Reports in Nephrology2090-66412090-665X2014-01-01201410.1155/2014/823093823093Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA AmyloidosisMasaru Matsui0Satoshi Okayama1Hideo Tsushima2Kenichi Samejima3Tomoko Kanki4Ayako Hasegawa5Katsuhiko Morimoto6Yasuhiro Akai7Masato Takano8Shiro Uemura9Chiho Ohbayashi10Yoshihiko Saito11First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanDepartment of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanDepartment of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanFirst Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, JapanSystemic reactive AA amyloidosis is a life-threatening complication of chronic inflammatory diseases. Anti-interleukin-6 receptor, tocilizumab (TCZ), has been shown to improve clinical symptoms of patients with AA amyloidosis, accompanied with regression of the amyloid deposition. We report a case of AA amyloidosis evaluated by histology of multiple organs before and after TCZ treatment. A woman in her 60s with rheumatoid arthritis was referred to our hospital because of cardiac and renal dysfunction. A gastric and renal biopsy revealed the deposition of AA amyloid, and echocardiography revealed concentric left ventricular hypertrophy. Her estimated glomerular filtration rate was decreased to 8.6 mL/min/1.73 m2, and B-type natriuretic peptide, C-reactive protein, and serum amyloid A protein were significantly elevated. TCZ treatments markedly decreased her serum amyloid A protein and C-reactive protein levels, but hemodialysis was required 1 year later. Endoscopic gastric rebiopsy 3 years after initiation of TCZ treatments revealed the regression of amyloid deposition and echocardiography revealed improvement of her left ventricular hypertrophy. However, a renal rebiopsy revealed that the amyloid deposition had not regressed. In conclusion, these observations suggest that the therapeutic effects of TCZ can vary among organs in patients with AA amyloidosis.http://dx.doi.org/10.1155/2014/823093 |
| spellingShingle | Masaru Matsui Satoshi Okayama Hideo Tsushima Kenichi Samejima Tomoko Kanki Ayako Hasegawa Katsuhiko Morimoto Yasuhiro Akai Masato Takano Shiro Uemura Chiho Ohbayashi Yoshihiko Saito Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis Case Reports in Nephrology |
| title | Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis |
| title_full | Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis |
| title_fullStr | Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis |
| title_full_unstemmed | Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis |
| title_short | Therapeutic Benefits of Tocilizumab Vary in Different Organs of a Patient with AA Amyloidosis |
| title_sort | therapeutic benefits of tocilizumab vary in different organs of a patient with aa amyloidosis |
| url | http://dx.doi.org/10.1155/2014/823093 |
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