An Interesting complication of pulmonary tuberculosis

Renal amyloidosis can occur as a primary or secondary, systemic or localized disorder. It is defined as a chronic infiltrative disorder characterized by impaired organ function caused by extracellular insoluble protein fibrils. We report a case of renal amyloidosis in a patient with pulmonary tuberculosis with bilateral bronchiectasis who presented with nephrotic syndrome.35 yr old male, who was a known case of pulmonary tuberculosis, was admitted with complaints of shortness of breath and swelling of legs and face. On examination patient had bilateral pedal edema, pan digital clubbing, JVP was not elevated and vitals were stable. Auscultation of chest revealed extensive crepitations and wheeze. Routine examination complete hemogram, renal function and liver function tests were within normal limits. Urine examination revealed 3 albuminuria. ECG normal. CXR right upper lobe fibrosis and left lung honey combing pattern. CT chest showed pulmonary tuberculosis with bilateral cystic changes and surrounding consolidation. - Echocardiogram was normal. Urine PCR 5.25. Hence we arrived at a diagnosis of nephrotic syndrome. We proceeded with renal biopsy which revealed amyloidosis. Immunofluorescent staining revealed AA amyloidosis. Hence it is a case of amyloidosis secondary to bilateral bronchiectasis and pulmonary tuberculosis. We would like to present this case as it made us look for secondary amyloidosis in patients with chronic infections and chronic inflammatory states.