A case of systemic amyloidosis associated with cyclic neutropenia

Pediatr Nephrol. 2011 Apr;26(4):625-9. doi: 10.1007/s00467-010-1715-7. Epub 2010 Dec 15.

Abstract

Reactive AA amyloidosis is caused by the accumulation of the acute phase reactant, serum amyloid A (SAA), as a complication of chronic inflammatory conditions. Cyclic neutropenia is a rare hereditary disorder characterized by repeated episodes of neutropenia at regular intervals, with or without concurrent infection, and is known to be a rare cause of AA amyloidosis. Here, we report a case of a patient who developed systemic AA amyloidosis following a prolonged course of undiagnosed cyclic neutropenia. The patient had a history of recurrent infections since infancy and developed goiter, proteinuria, and azotemia at age 14 years. Her SAA level was markedly increased (601.8 μg/mL, normal range <8 μg/mL), and a thyroid and kidney biopsy revealed typical lesions of AA amyloidosis. Amyloid deposits were also detected in the myocardium, colon, and gallbladder. She had repeated episodes of neutropenia regularly at 3-week intervals and a pathogenic mutation in the ELA2 gene. After 10 months of treatment with recombinant human granulocyte colony-stimulating factor, her SAA level normalized (<2.5 μg/mL), but her renal function did not recover. This case clearly shows that cyclic neutropenia can be complicated by AA amyloidosis unless it is detected early and treated adequately.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Amyloidosis / etiology*
  • Amyloidosis / physiopathology
  • Female
  • Humans
  • Leukocyte Elastase / genetics
  • Mutation
  • Neutropenia / complications
  • Neutropenia / genetics
  • Neutropenia / physiopathology

Substances

  • Leukocyte Elastase

Supplementary concepts

  • Cyclic neutropenia