Systemic reactive
AA amyloidosis is a life-threatening complication of chronic inflammatory diseases. Anti-interleukin-6 receptor,
tocilizumab (TCZ), has been shown to improve clinical symptoms of patients with
AA amyloidosis, accompanied with regression of the
amyloid deposition. We report a case of
AA amyloidosis evaluated by histology of multiple organs before and after TCZ treatment. A woman in her 60s with
rheumatoid arthritis was referred to our hospital because of cardiac and renal dysfunction. A gastric and renal biopsy revealed the deposition of AA
amyloid, and echocardiography revealed concentric
left ventricular hypertrophy. Her estimated glomerular filtration rate was decreased to 8.6 mL/min/1.73 m(2), and
B-type natriuretic peptide,
C-reactive protein, and
serum amyloid A protein were significantly elevated. TCZ treatments markedly decreased her
serum amyloid A protein and
C-reactive protein levels, but
hemodialysis was required 1 year later. Endoscopic gastric rebiopsy 3 years after initiation of TCZ treatments revealed the regression of
amyloid deposition and echocardiography revealed improvement of her
left ventricular hypertrophy. However, a renal rebiopsy revealed that the
amyloid deposition had not regressed. In conclusion, these observations suggest that the
therapeutic effects of TCZ can vary among organs in patients with
AA amyloidosis.