Thirty years with Psoriasis- now progressing to rare complications!
A 45-year-old female, known case of Psoriasis, presented with complaints of worsening general condition and edema of the lower limbs for the past one month. The patient was diagnosed with psoriasis vulgaris around 30 years back, and since then, there have multiple relapses and remission. The disease has progressed to cause arthralgia and deformities of the extremities (feet and hand).
Past medical history revealed neoplasia of the right breast, which was treated around 4 years back.
On examination, the patient had a blood pressure of 120/75 mmHg. She had visible deformities of the hands and feet.
Serological investigations revealed:
- Mild leukocytosis,
- A moderate increase in inflammatory markers
- Hypoproteinemia at 51 g/l
- Hypoalbuminemia at 22 g/l
- Proteinuria of 24 hours at 3.27 g/24 h
- Normal renal function tests
- Normal liver function tests
Unrinalysis revealed sterile urine without any blood (hematuria).
Cardica examination and investigations were normal.
The patient was diagnosed with adult nephrotic syndrome.
A renal biopsy puncture was performed to confirm the diagnosis. Histopathological evaluation showed extravascular amyloid deposits in Congo Red stain.
Hand radiographs were performed. The radiographs and the clinical presentation favored the diagnosis of psoriatic arthritis.
The patient was diagnosed with renal amyloidosis secondary to psoriatic arthritis.
The patient was started on nephroprotective treatment, emollients, and topical corticosteroids. She was referred to a rheumatologist for evaluation of treatment with biological agents (anti-TNF).
The patient showed improvement over the next 6 months.
Secondary amyloidosis (now called AA amyloidosis) can occur secondary to chronic infections and chronic inflammatory conditions such as rheumatic disorder, but it has been rarely seen to be secondary to Psoriasis.
Amyloidoses is a group of disorders characterized by amyloid (protein) deposits in different body organs. The disease has been divided into certain types depending upon the type of amyloid; for example, AA amyloidosis (secondary amyloidosis) has deposits of amyloid type A protein.
It is imperative to consider Psoriasis in the differentials in such cases as seen here, to allow early treatment subsequently, hence a greater chance at a favorable course.
References:
El Amraoui M, Hjira N, Boui M (2018) When a Psoriasis Shows Its Claws!!!. Clin Med Img Lib 4:081. doi.org/10.23937/2474-3682/1510081
Stanford Healthcare: https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/amyloidosis/types/aa-secondary-amyloidosis.html
