Secondary renal amyloidosis complicating psoriatic arthropathy

Introduction: Secondary AA amyloidosis is a classical complication of chronic inflammatory conditions like rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease or chronic infectious diseases like tuberculosis, bronchiectasis and chronic osteomyelitis. Amyloidosis is an extremely rare complication of psoriatic arthritisand is associated with a poor prognosis.1-3 Materials and Methods: We report a case of a 42 year old male, a known case of psoriasis since 1 year and on methotrexate 15mg /day since 6 month in view of psoriatic arthropathy. Laboratory findings revealed urinary spot protein in the nephrotic range along with hyperlipidemia, hypoproteinemia and albuminuria suggestive of nephrotic syndrome. USG guided renal biopsy revealed renal amyloidosis with congo red positivity showing apple green birefringence. Patient expired within 48 hours after renal biopsy due to pneumonia. Complete autopsy was performed and histopathology showed amyloidosis restricted to the kidneys. Result: USG guided renal biopsy revealed renal amyloidosis with congo red positivity showing apple green birefringence. Patient expired within 48 hours after renal biopsy due to pneumonia. Complete autopsy was performed and histopathology showed amyloidosis restricted to the kidneys. Conclusion: Amyloidosis should be considered in patients with long-standing severe psoriasis and psoriatic arthropathy who develop renal symptoms and there can be rapid onset of amyloidosis after the first articular signs. Prognosis is usually poor.