title: Successful use of tocilizumab in a patient with nephrotic syndrome due to a rapidly progressing AA amyloidosis secondary to latent tuberculosis.
abstract: 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.
authors: Department of Rheumatology, Hospital Universitario San Cecilio, Granada, Spain. cesar_magro@yahoo.es
authors: César
authors: C
authors: Magro-Checa
authors: Antonio
authors: A
authors: Navas-Parejo Casado
authors: Elena
authors: E
authors: Borrego-García
authors: Enrique
authors: E
authors: Raya-Álvarez
authors: José Luis
authors: JL
authors: Rosales-Alexander
authors: Juan
authors: J
authors: Salvatierra
authors: Trinidad
authors: T
authors: Caballero-Morales
authors: Mercedes
authors: M
authors: Gómez-Morales
mesh_terms: D000328:Adult; D000686:Amyloidosis / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D003106:Colon / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007668:Kidney / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D009404:Nephrotic Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D011507:Proteinuria / Q000188:drug therapy; D011859:Radiography; D000685:Serum Amyloid A Protein / Q000378:metabolism; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014463:Ultrasonography
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D000685:Serum Amyloid A Protein; C502936:tocilizumab; D007538:Isoniazid