Amyloidosis and Giant Cell Arteritis/Polymyalgia Rheumatica

Abstract

To the Editor: Secondary amyloidosis can develop in a patient with seemingly quiescent giant cell arteritis/polymyalgia rheumatica (GCA/PMR). We describe a patient with clinically quiescent GCA who developed AA amyloidosis of the kidney, resulting in nephrotic syndrome and acute renal failure. A 79-year-old woman presented to the rheumatology service in December 2009 with new-onset unilateral headache and prominence and tenderness of the left temporal artery. Erythrocyte sedimentation rate (ESR) was 85 mm/h and C-reactive protein (CRP) was 40.9 mg/l. She fulfilled 4 of the 5 American College of Rheumatology (ACR) 1990 criteria for GCA: age > 50 years, new-onset headache, temporal artery abnormality, and ESR > 50 mm/h1. She denied symptoms of PMR but she had anorexia and generalized fatigue that had been persistent for several years. Subsequent investigations for GCA included left-side temporal artery biopsy of 1 cm and magnetic resonance imaging (MRI) of the scalp vessels with contrast. The temporal artery biopsy was negative for evidence of arteritis; however, the MRI showed abnormal enhancement in the superficial temporal artery in the postcontrast images. This finding was felt to be diagnostic of arteritis. The patient had a 35 pack-years smoking history with moderate chronic obstructive pulmonary disease (COPD) and a history of tuberculosis treated in 1951 with residual right-upper lobe traction bronchiectasis, demonstrable on computerized tomography (CT) scan. She experienced on average 1 infectious exacerbation per year and in the intervening period had no baseline sputum production. She also had hypertension, paroxysmal atrial fibrillation, and hypothyroidism. She was initially treated for GCA with prednisone 50 mg daily for 3 weeks, with complete resolution … Address correspondence to Dr. Legault; E-mail: kimberly.legault{at}medportal.ca