Department of Rheumatology, Hospital Universitario San Cecilio, Granada, Spain.
Amyloid. 2011 Dec;18(4):235-9. doi: 10.3109/13506129.2011.613962. Epub 2011 Oct 12.
AA (secondary) amyloidosis is one of the most severe and uncommon complications of several rheumatic disorders and chronic infections such as tuberculosis (TB). Successful treatment depends on the control of the underlying inflammatory process, what can lead to an improvement or a regression in organ dysfunction. If the disorder persists, it has been reported in some cases of AA amyloidosis secondary to rheumatic diseases, that the use of biologic therapy is so far the only opportunity to reduce the development of AA amyloidosis and to reverse established deposits. We report herein a case of a latent TB infection complicated by a life-threatening AA amyloidosis presented as nephrotic syndrome. After an adequate antituberculostatic treatment, AA amyloidosis remained active and Tocilizumab (TCZ) was started with a dramatic resolution of the proteinuria, stabilization of the amyloid deposits and improvement in general condition.
AA（继发性）淀粉样变是几种风湿性疾病和慢性感染（如结核，TB）的最严重和罕见的并发症之一。成功的治疗取决于对潜在炎症过程的控制，这可以导致器官功能障碍的改善或逆转。如果疾病持续存在，据报道，在一些继发于风湿性疾病的 AA 淀粉样变性病例中，生物治疗是迄今为止减少 AA 淀粉样变性发展和逆转已建立的沉积物的唯一机会。我们在此报告一例潜伏性结核感染并发危及生命的 AA 淀粉样变性，表现为肾病综合征。在进行充分的抗结核治疗后，AA 淀粉样变性仍然活跃，使用托珠单抗（TCZ）后蛋白尿显著缓解，淀粉样沉积物稳定，一般状况改善。
