Abstract
The patient was a 43 year old female who had been diagnosed as having rheumatoid arthritis (RA) 17 years before, had an 8 year history of congestive heart failure and had suffered from chronic renal failure for 2 years.
Four months prior to admission to our hospital, hemodialysis therapy for chronic renal failure was initiated at another hospital. She was admitted in our facilities for control of nausea, anorexia and congestive heart failure.
The cardiothoracic ratio was 58.8%, ECG showed a QS pattern in leads V1, V2 and UCG disclosed a granular sparkling appearance of the interventricular septum. Gastro-duodenal, rectal and cardiac biopsy contained amyloid deposition that stained positively with Congo-red, was birefringent and was sensitive to KMnO4 treatment. Moreover, immunohistochemical staining (PAP method) revealed β2-microglobulin (β2-MG) and amyloid A (AA) protein antigenicity in the same area of amyloid deposition.
After the application of a cellulose triacetate membrane from cuprophan to decrease the serum AA protein and β2-MG and ingestion of 20% DMSO solution to dissociate the deposited amyloid, the patient's general condition was markedly improved. However, these therapies for inducing regression of amyloidosis are obscure.
