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Vol. 16. Issue 6.
Pages 493-496 (November - December 2020)
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Vol. 16. Issue 6.
Pages 493-496 (November - December 2020)
Case report
DOI: 10.1016/j.reuma.2018.09.001
AA amyloidosis associated with morbid obesity (clinical case)
Amiloidosis AA asociada a la obesidad mórbida (caso clínico)
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Nana Beridze Vaktangovaa,
Corresponding author
nmedik1@gmail.com

Corresponding author.
, Vanesa García Moreiraa, Sandra García Castañóna, Raúl Rodríguez Aguilarb, Francisco Domínguez Iglesiasb
a Clinical Analysis Service, Cabueñes Hospital, 33394 Gijón, Asturias, Spain
b Pathological Anatomy Service, Cabueñes Hospital, Gijón, Asturias, Spain
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Abstract

We present the case of a 45-year-old woman who was hospitalized due to severe macrocytic anemia and renal failure. The patient presented a morbid obesity.

The immunological study showed anti-ENA anti-SSA (Ro52) positive, with negative antinuclear antibodies. Also in the proteinogram (serum immunofixation) the presence of monoclonal bands IgG lambda and IgG kappa, monoclonal component 7.2% (4.68g/L), with elevation of free light chains (kappa 95.94mg/L (3.3–19.4), evidenced, lambda 145.17mg/L (5.71–26.3)).

The bone marrow study showed an infiltration of 5% of plasma cells and positive for AA amyloid. Finally, a percutaneous renal biopsy was performed, which again showed amyloid infiltration.

In the genetic study, 2 mutations of the family Mediterranean fever gene (MEFV) have been identified.

Secondary AA amyloidosis has been described associated with obesity, in addition to a percentage of cases of unknown etiology.

Keywords:
Amyloidosis
Obesity
Familial Mediterranean fever
Resumen

Presentamos el caso de una mujer de 45 años que fue hospitalizada debido a una anemia macrocítica severa e insuficiencia renal. El paciente presentaba una obesidad mórbida.

El estudio inmunológico mostró positividad para anti-ENA, anti-SSA (Ro52) y negatividad para anticuerpos antinucleares. También en el proteinograma (inmunofijación sérica) se detectó la presencia de bandas monoclonales IgG lambda e IgG kappa, con un componente monoclonal del 7,2% (4,68g/l) y la elevación de cadenas ligeras libres (kappa 95,94mg/l [3,3-19,4]; lambda 145,17mg/l [5,71-26,3]).

El estudio de biopsia de médula ósea mostró una infiltración del 5% de células plasmáticas y positividad para amiloide AA. Finalmente, se realizó una biopsia renal que nuevamente mostró infiltración amiloide.

En el estudio genético se identificaron 2 mutaciones del gen de la fiebre mediterránea familiar (MEFV).

La amiloidosis secundaria AA se ha descrito asociada a la obesidad, además de un porcentaje de casos de etiología desconocida.

Palabras clave:
Amiloidosis
Obesidad
Fiebre Mediterránea Familiar

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