Systemic Amyloid Protein a Amyloidosis Involving the Heart in a Patient with Rheumatoid Arthritis

Hwang, Ji-won; Jeon, Eun-Seok; Ha, Jung Min; Lee, Woo Joo; Kim, Eun; Yune, Sehyo

doi:2014.86.6.739

Korean J Med > Volume 86(6); 2014 > Article

Case Report

The Korean Journal of Medicine 2014;86(6):739-743.
Published online June 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.86.6.739

Systemic Amyloid Protein a Amyloidosis Involving the Heart in a Patient with Rheumatoid Arthritis

Ji-won Hwang¹, Eun-Seok Jeon², Jung Min Ha¹, Woo Joo Lee¹, Eun Kim¹, Sehyo Yune¹

¹Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
²Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

류마티스 관절염 환자에서 심장 조직 검사로 확진된 아밀로이드 단백 A 심장 아밀로이드증

황지원¹, 전은석², 하정민¹, 이우주¹, 김은¹, 윤세효¹

^¹성균관대학교 의과대학 삼성서울병원 내과
^²성균관대학교 의과대학 삼성서울병원 순환기내과 심혈관센터

Correspondence:
Eun-Seok Jeon, Tel: +82-2-3410-3419, Fax: +82-2-3410-3849, Email: eunseok.jeon@samsung.com

Received: 31 May 2013 • Revised: 8 July 2013 • Accepted: 26 July 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Amyloidosis can be identified by the deposition of amyloid fibrils in biopsy specimens from multiple organs, including the heart, kidney, skin, and bowel. Systemic amyloid protein A amyloidosis (AA amyloidosis) is commonly associated with chronic inflammatory diseases or chronic infectious conditions. Cardiac involvement in AA amyloidosis is found in < 1% of reported cases. Here, we report a case of cardiac AA amyloidosis confirmed by heart biopsy in a 54-year-old-female with a medical history of rheumatoid arthritis and stage 4 chronic kidney disease due to renal amyloidosis. She had suffered from progressive aggravation of dyspnea for 2 years. Infiltrative disease involving the heart was suspected by echocardiography, and the patient was diagnosed with AA amyloidosis involving the heart by cardiac biopsy. This is a rare case of cardiac involvement in a patient with systemic AA amyloidosis associated with rheumatoid arthritis. (Korean J Med 2014;86:739-743)

Key Words: Systemic amyloid protein A amyloidosis (AA amyloidosis); Congestive heart failure; Rheumatic arthritis

주제어: 전신적 아밀로이드 단백질 A 아밀로이드증(AA 아밀로이드증); AA 아밀로이드 심근증; 울혈성 심부전;