Doxycycline treatment in dialysis related amyloidosis: discrepancy between antalgic effect and inflammation, studied with FDG-positron emission tomography: a case report

• Published in: BMC nephrology Vol. 18; no. 1; p. 285
• Main Authors: Piccoli, Giorgina Barbara, Hachemi, Mammar, Molfino, Ida, Coindre, Jean Philippe, Boursot, Charles
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.09.2017; BioMed Central; BMC
• Subjects: Amyloidosis; Amyloidosis - diagnostic imaging; Amyloidosis - drug therapy; Amyloidosis - etiology; Anti-Bacterial Agents - therapeutic use; Anti-inflammatory agents; Antibiotics; Cancer therapies; Care and treatment; Case Report; Case reports; Case studies; Complications and side effects; Congenital diseases; Diagnosis; Dialysis related amyloidosis; Disease; Dosage and administration; Doxycycline; Doxycycline - therapeutic use; Drug dosages; Drug therapy; Female; Fluorodeoxyglucose F18; Hemodiafiltration; Hemodialysis; Humans; Hypoplasia; Inflammation; Inflammation - diagnostic imaging; Inflammation - drug therapy; Inflammation - etiology; Kidneys; Long-term survival; Medical imaging; Metabolism; Middle Aged; Nephrology; Pain; Patients; Positron emission tomography; Positron-Emission Tomography - methods; Renal Dialysis - adverse effects; Risk factors; Treatment Outcome; β-Amyloid; France; Long-term survival; Hemodiafiltration; Dialysis related amyloidosis; Hemodialysis; Positron emission tomography; Doxycycline
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-017-0698-z

No effective treatment is currently available and dialysis related amyloidosis continues to be invalidating in long-term dialysis patients. A recent case series reported reduction of osteoarticular pain on doxycycline treatment, extending the indications of this drug, used in other uncommon forms of amyloidosis, to dialysis patients. Explanations of the antalgic effect were the anti-inflammatory properties and anti-coiling effects of tetracycline. Our report regards a 54-year-old woman, who was never transplanted and has been on hemodialysis and hemodiafiltration for overall 37 years, due to renal hypoplasia. In spite of high efficiency hemodiafiltration, she complained of increasing, invalidating osteoarticular pain; history and imaging suggested beta-2 microglobulin amyloid. Positron emission tomography (PET scan) identified metabolically active lesions in the involved settings. Low-dose doxycycline (100 mg/day) was started, leading to a considerable decrease in pain (over 6 months, from 7 to 8 to 4-5 on a 0-10 scale). At 6 months, a PET scan showed unmodified or increased uptake in the involved settings. In summary, the previously described antalgic effect of doxycycline in dialysis related amyloidosis is confirmed in our case, the first studied using PET scan. The pattern at PET can suggests that the antalgic effect is independent from inflammation and points to other factors, such as interaction with fibril geometry or with bone structure.