A case of fever of unknown origin (FUO) caused by dialysis-related amyloidosis (DRA) in a patient on long-term hemodialysis therapy

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  • Ishii Tomoko
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Ohtake Takayasu
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Oka Machiko
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Maesato Kyoko
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Mano Tsutomu
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Ikee Ryota
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Moriya Hidekazu
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital
  • Aso Kuniko
    Shonan Kasama Clinic
  • Kobayashi Shuzo
    Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital

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Other Title
  • 不明熱の原因が透析アミロイドーシスであった長期透析患者の１例
  • 症例報告 不明熱の原因が透析アミロイドーシスであった長期透析患者の1例
  • ショウレイ ホウコク フメイ ネツ ノ ゲンイン ガ トウセキ アミロイドーシス デ アッタ チョウキ トウセキ カンジャ ノ 1レイ

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Abstract

A 63 year-old Japanese man on long-term hemodialysis therapy (for 25 years) developed fever, erythropoietin-resistant anemia, and elevated C-reactive protein (CRP) in March 2005. Empiric antibiotic therapy failed to improve the clinical symptoms, and he was admitted to our hospital for fever of unknown origin (FUO) in June 2005. On admission, he showed painless swelling of the left shoulder joint. Both bone scintigraphy and galium scintigraphy demonstrated strong uptake to the left shoulder joint. A synovial membrane biopsy of the left shoulder joint demonstrated positive β2 microglobulin (β2-MG) immunostaining, and he was diagnosed as having arthropathy due to dialysis-related amyloidosis (DRA). He received β2-MG adsorption therapy using a β2-MG adsorption column (Lixelle®) and corticosteroid therapy (prednisolone 10 mg/day). Thereafter, his symptoms and laboratory data such as anemia and elevated CRP dramatically improved. The main causes of FUO are generally considered due to malignancy, chronic infection, or collagen diseases. However, in cases of FUO on long-term hemodialysis therapy, DRA should also be examined as a possible cause of FUO.

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