UNUSUAL AND MEMORABLE

Case Number 29: Hitting three with one strike: rapid improvement of psoriatic arthritis, psoriatic erythroderma, and secondary renal amyloidosis by treatment with infliximab (Remicade)

C Fiehn¹, K Andrassy²

Series editor: Gary D Wright

¹ Department of Internal Medicine V, University Hospital of Heidelberg, Germany
² Department of Internal Medicine I, Section of Nephrology, University Hospital of Heidelberg, Germany

Correspondence to:
Correspondence to:
Dr C Fiehn
Department of Internal Medicine V, University of Heidelberg, Hospitalstr. 3, 69123 Heidelberg, Germany; christoph_fiehn@med.uni-heidelberg.de

Keywords: psoriatic arthritis; amyloidosis; psoriasis vulgaris; infliximab

The first 150 words of the full text of this article appear below.

A 64 year old woman presented with a 30 year history of psoriasis vulgaris and polyarticular psoriatic arthritis as well as a newly diagnosed renal insufficiency. At the physical examination she showed severe psoriatic erythroderma (fig 1A) and signs of destructive polyarthritis of the joints of the fingers and feet. Radiology disclosed almost complete ankylosis of both wrists, and high grade erosive destruction of the small joints of fingers and toes. Serum creatinine was 330 µmol/l and blood urea nitrogen (BUN) 40 mmol/l. Urine examinations showed a proteinuria of 8 g/24 h (normal value <0.1). Renal biopsy revealed severe AA amyloidosis of the kidneys as the cause of renal insufficiency and nephrotic syndrome. With the exception of ibuprofen she had not so far received regular treatment of her disease.

View larger version (72K): [in this window] [in a new window]   Figure 1 Psoriatic erythroderma (A) before the onset of treatment with 200 mg (3.3 mg/kg) infliximab (Remicade) intravenously and (B) after two . . . [Full text of this article]

 

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