Abstract

We present the case of a 45-year-old woman who was hospitalized due to severe macrocytic anemia and renal failure. The patient presented a morbid obesity.The immunological study showed anti-ENA anti-SSA (Ro52) positive, with negative antinuclear antibodies. Also in the proteinogram (serum immunofixation) the presence of monoclonal bands IgG lambda and IgG kappa, monoclonal component 7.2% (4.68 g/L), with elevation of free light chains (kappa 95.94 mg/L (3.3–19.4), evidenced, lambda 145.17 mg/L (5.71–26.3)).The bone marrow study showed an infiltration of 5% of plasma cells and positive for AA amyloid. Finally, a percutaneous renal biopsy was performed, which again showed amyloid infiltration.In the genetic study, 2 mutations of the family Mediterranean fever gene (MEFV) have been identified.Secondary AA amyloidosis has been described associated with obesity, in addition to a percentage of cases of unknown etiology.Presentamos el caso de una mujer de 45 años que fue hospitalizada debido a una anemia macrocítica severa e insuficiencia renal. El paciente presentaba una obesidad mórbida.El estudio inmunológico mostró positividad para anti-ENA, anti-SSA (Ro52) y negatividad para anticuerpos antinucleares. También en el proteinograma (inmunofijación sérica) se detectó la presencia de bandas monoclonales IgG lambda e IgG kappa, con un componente monoclonal del 7,2% (4,68 g/l) y la elevación de cadenas ligeras libres (kappa 95,94 mg/l [3,3-19,4]; lambda 145,17 mg/l [5,71-26,3]).El estudio de biopsia de médula ósea mostró una infiltración del 5% de células plasmáticas y positividad para amiloide AA. Finalmente, se realizó una biopsia renal que nuevamente mostró infiltración amiloide.En el estudio genético se identificaron 2 mutaciones del gen de la fiebre mediterránea familiar (MEFV).La amiloidosis secundaria AA se ha descrito asociada a la obesidad, además de un porcentaje de casos de etiología desconocida.

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