[AA amyloidosis: a little-known complication of chronic leg ulcer].
BACKGROUND
AA amyloidosis, secondary to inflammatory chronic diseases like rheumatoid arthritis, is often complicated by renal failure. Chronic inflammatory dermatoses constitute rare causes of AA amyloidosis.


METHODS
We describe two cases of AA amyloidosis discovered after renal failure in patients presenting leg ulcers for several years. AL amyloidosis was suspected in both cases because of a history of monoclonal gammopathy in one patient and of plasmocytoma in the other. The diagnosis of AA amyloidosis was confirmed on renal histology through the detection of AA antibodies in amyloid deposits. No extrarenal amyloidosis was seen in either patient and there were no inflammatory diseases other than chronic leg ulcers.


CONCLUSIONS
AA amyloidosis is caused by serum amyloid protein A (SAA), a reactive inflammatory protein. AA amyloidosis is thus caused by chronic inflammatory diseases, but only rarely by cutaneous inflammatory diseases. To our knowledge, the literature contains only seven other published cases of AA amyloidosis secondary to chronic leg ulcers. A review of the literature does not indicate whether cure of ulcers has any effect on the accompanying renal failure. We imagine that AA amyloidosis secondary to leg ulcer is in fact under-diagnosed. However, since the first specific treatment for AA amyloidosis is currently being evaluated by the Food and Drug Administration, it is essential that this serious complication of chronic leg ulcers be widely recognised.
Waton
J
J
Service de dermatologie, hôpital Fournier-CHU, 36, quai de la Bataille, 54000 Nancy, France. j.waton@chu-nancy.fr
Fays-Michel
S
S
Chandeclerc
M L
ML
Corby
S
S
Cuny
J F
JF
Barbaud
A
A
Schmutz
J-L
JL
D000368:Aged; D000686:Amyloidosis / Q000209:etiology*; D002908:Chronic Disease; D006801:Humans; D007142:Immunoglobulin gamma-Chains / Q000032:analysis; D007145:Immunoglobulin kappa-Chains / Q000032:analysis; D007146:Immunoglobulin lambda-Chains / Q000032:analysis; D007674:Kidney Diseases / Q000209:etiology*; D007871:Leg Ulcer / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications; D010954:Plasmacytoma / Q000150:complications; D051437:Renal Insufficiency / Q000209:etiology; D000685:Serum Amyloid A Protein / Q000032:analysis*
D007142:Immunoglobulin gamma-Chains; D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D000685:Serum Amyloid A Protein