Chronic and severe prosthetic joint infection complicated by amyloid A amyloidosis with renal and bladder impairment

• Published in: BMJ case reports Vol. 2018; p. bcr-2017-223491
• Main Authors: Benech, Nicolas, Lustig, Sebastien, Chidiac, Christian, Ferry, Tristan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 05.02.2018; BMJ Publishing Group
• Subjects: Aged; Amputation - methods; Amyloidosis; Amyloidosis - complications; Bacterial infections; Bacteriology; Biopsy; Bone Neoplasms - surgery; Case reports; Family medical history; Female; Hematuria - etiology; Humans; Images In; Immunology; Infections; Kidney diseases; Knee Prosthesis - adverse effects; Life Sciences; Medical imaging; Methicillin Resistance; Microbiology and Parasitology; Patients; Prostheses; Prosthesis-Related Infections - complications; Prosthesis-Related Infections - surgery; Proteins; Renal Insufficiency - complications; Serum Amyloid A Protein - metabolism; Urinary Bladder Diseases - complications; Virology; bone and joint infections; orthopaedics
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-223491

Lab results found inflammatory syndrome (C reactive protein: 69.5mg/L), normocytic anaemia (77g/L haemoglobin) and a stage 4 chronic kidney disease (glomerular filtration rate: 26.3mL/min vs 110mL/min in 2011; Chronic Kidney Disease Epidemiology Collaboration equation); proteinuria (1.58g/24hours) was associated. After evaluation of the risk-benefit ratio, the nephrologist considered that a kidney biopsy was not required to confirm the diagnosis, as two histological samples shown AA amyloid deposits, and other diagnosis were unlikely. AA amyloid fibrils are derived from serum amyloid A protein and accumulate in tissue leading to organ dysfunction. 1 In the largest published cohort of 374 patients with AA amyloidosis, osteomyelitis was the underlying disease for 1.3% of patients (5/374).