Клинический случай запоздалой диагностики вторичного АА-амилоидоза у пациента с псориатическим артритом: КЛИНИЧЕСКИЙ СЛУЧАЙ

Камаль Джасер Юнус  Алкак; Яна Эдуардовна  Булавко; Гульмира Абдалиевна  Ибраева; Владимир Анатольевич  Исаков; Мадина Гасаналиевна  Караева

doi:10.56871/MTP.2026.93.96.009

A clinical case of delayed diagnosis of secondaryAA amyloidosis in a patient with psoriatic arthritis

CLINICAL CASE

Kamal D. Yu. Alkak Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation https://orcid.org/0000-0003-3652-6373
Yana E. Bulavko Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation https://orcid.org/0000-0003-0879-846X
Gulmira A. Ibraeva Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation https://orcid.org/0009-0008-6139-7829
Vladimir A. Isakov Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation https://orcid.org/0000-0003-2014-0847
Madina G. Karaeva City Mariinsky Hospital, 56 Liteyny ave., Saint Petersburg, 191014, Russian Federation https://orcid.org/0009-0004-1554-0154

Keywords:

AA amyloidosis SAA-protein amyloid nephropathy renal replacement therapy delayed diagnosis renal biopsy nephrotic syndrome psoriatic arthritis exudative psoriasis AA-амилоидоз SAA-белок амилоидная нефропатия заместительная почечная терапия запоздалая диагностика нефробиопсия нефротический синдром псориатический артрит экссудативный псориаз

Abstract

AA amyloidosis (Amyloid A protein) is a rare but severe complication of psoriatic arthritis, leading to irreversible damage in the kidneys, intestines, and other internal organs. The prolonged latent course of renal amyloidosis and low awareness among primary care physicians often result in delayed diagnosis. This article presents a clinical case of a 44-year-old male with a 20-year history of exudative psoriasis and psoriatic arthritis. Despite early laboratory signs of kidney involvement (elevated serum creatinine up to 311μmol/L) recorded two years prior to hospitalization, a targeted examination was not performed. The patient was admitted to the hospital with a full-blown picture of renal failure, nephrotic syndrome, and active joint and skin inflammation. The diagnosis of AA amyloidosis was confirmed by renal biopsy, which revealed massive amyloid deposits in the glomeruli, tubules, and renal vessels, total acute tubular necrosis, and severe fibrosis. Renal replacement therapy was initiated. The administration of methotrexate failed to alleviate the symptoms of arthritis. A nosocomial infection involving the urinary tract and intestines subsequently occurred. The patient died due to multiple organ failure. The management of patients with chronic immune-mediated inflammatory diseases requires close collaboration between dermatologists, rheumatologists, and nephrologists. Dermatologists must be aware of the risk of systemic complications of psoriasis and psoriatic arthritis. Patients with active and/or long-standing psoriatic arthritis should undergo regular monitoring (at least every 6-12 months) for proteinuria, serum creatinine, C-reactive protein, and possibly serum amyloid A (SAA) protein levels to control inflammatory activity and enable early detection of nephropathy.

Author Biographies

Kamal D. Yu. Alkak, Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation

Assistant of the Department of Propaedeutics of Internal Medicine

Yana E. Bulavko, Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation

Assistant of the Department of Propaedeutics of Internal Medicine

Gulmira A. Ibraeva, Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation

Assistant of the Department of Propaedeutics of Internal Medicine

Vladimir A. Isakov, Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, 194100, Russian Federation

Cand. Sci. (Med.), Head of the Department of Propaedeutics of Internal Medicine, Physician of the Therapeutic Department

Madina G. Karaeva, City Mariinsky Hospital, 56 Liteyny ave., Saint Petersburg, 191014, Russian Federation

Nephrology Department
Physician

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A clinical case of delayed diagnosis of secondaryAA amyloidosis in a patient with psoriatic arthritis: CLINICAL CASE. (2026). Medicine: Theory and Practice, 11(1), 104-113. https://doi.org/10.56871/MTP.2026.93.96.009

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A clinical case of delayed diagnosis of secondaryAA amyloidosis in a patient with psoriatic arthritis: CLINICAL CASE. (2026). Medicine: Theory and Practice, 11(1), 104-113. https://doi.org/10.56871/MTP.2026.93.96.009

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