Systemic Amyloidosis Secondary to Psoriasis: A Rare, Autoimmune and Genetically-Determined Disorder That Is Amenable to Treatment with Cyclosporin A<br>—Cyclosporin A for Psoriasis-Induced Amyloidosis
- 1 Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- 2 Asad Al-Hamad Dermatology Center, Kuwait City, Kuwait
- 3 Department of Pathology, Amiri Hospital, Kuwait City, Kuwait
Abstract
<b>Background:</b><b> </b>Systemic secondary amyloidosis (SSA) is associated with chronic inflammatory disorders and/or chronic infections. <b>Patients</b><b> </b><b>and</b><b> </b><b>Methods</b><b>:</b> Over the past 10 years; a total of 21 patients, with long-term (≥17 months) and extensive psoriasis (P) with psoriasis area severity index (PASI) >29, were evaluated. <b>Results:</b><b> </b>Two patients had nephrotic syndrome (proteinuria 3.9 and 3.6 g/day) and decrease creatinine clearance (46 and 62 ml/minute). Their renal biopsy revealed Congo-red (+) nodular glomerulosclerosis that lacked immune-deposits and resisted wash with K-permanganate wash indicating SSA. Three months subsequent to Cyclosporin A (CyA) therapy with 100 mg twice daily; psoriasis improved in all patients with decrease in (PASI) from ≥29.5 to ≤3.5 1. In the 2 patients with SSA; proteinuria decreased to 2.1 and 1.8 g/day and creatinine clearance improved to 51 and 69 ml/minute. Such improvement persisted up to ≥2 years of follow up and up to ≥78 months in patients with SSA. <b>Conclusion</b><b>:</b><b> </b>psoriasis-induced SSA is an autoimmune disease, with genetic predisposition that is amenable to CyA therapy.
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