Secondary AA type amyloidosis associated with multiple sclerosis

Abstract

Background Secondary AA type amyloidosis can occur as a complication of chronic systemic inflammatory and infectious diseases. Multiple sclerosis (MS) is thought to be an autoimmune demyelinating disease of the central nervous system and there is no report about secondary AA type amyloidosis associated with MS, although cerebrovascular amyloid deposit in the region near the demyelinated plaques was reported in rare cases of multiple sclerosis. We report renal biopsy-proven secondary AA type amyloidosis in a patient with multiple sclerosis.

Case A 41 year-old female patient was hospitalized due to aggravated quadriparesis. She had been diagnosed as multiple sclerosis at age 33. At age 26, the patient experienced the first episode of quadriparesis with sensory change of both lower extremities and admitted to other hospital. Those symptoms were improved although mild paraparesis remained. At age 33, she noticed decreased visual acuity for several days. At age 40, she had admitted to another hospital due to quadriparesis, dysarthria and confusional mentality and was transferred to our hospital and steroid pulse therapy was done. Her Brain MRI showed medulla and upper cervical lesions. She was improved and discharged. However, her quadriparesis was aggravated and she complained of edema in both lower extremities at age 41. Laboratory findings showed proteinuria (4831mg/day) and hypoalbuminemia (2.8mg/dL). She was diagnosed with nephrotic syndrome. In order to determine the cause of the nephrotic syndrome, a percutaneous renal biopsy was performed. On immunofluorescence microscopy, IgM, IgA, and C3 were observed. In immunohistochemical staining, AA type amyloidosis was confirmed. Consequently, this case was diagnosed as secondary AA type amyloidosis associated with multiple sclerosis.

Conclusions In this case, systemic AA type amyloidosis was thought to be secondarily induced by multiple sclerosis. This is the first report of secondary AA type amyloidosis associated with multiple sclerosis.