A 67-year-old male patient diagnosed in 1995 with FMF due to recurrent and self-limiting episodes of abdominal pain and fever.
After diagnosis, treatment with colchicine was prescribed at a dose of 0.5 mg every 12 h, and the patient remained asymptomatic for the following years.
In November 2010, colchicine was suspended by the primary care physician, after which the patient began to present episodes of polyarthralgia, chest pain and abdominal pain.
In January 2011, the patient was referred to our center for study.
At the time of consultation, the patient was afflicted, blood pressure was 95/71 mmHg and heart rate was 83 beats per minute.
The only notable finding on physical examination was the presence of mild malleolus edema.
The patient had a serum creatinine of 1.33 mg/dl, serum albumin of 2.14 g/dl, cholesterol of 285 mg/dl and triglycerides of 295 mg/dl. The proteinuria was 6.1 g/day.
Urine sediment showed 15 parasites per field.
The rest of analytical parameters, including leukocytes, platelets and hemoglobin, were normal.
Mantoux test was negative.
Having suspected that the patient had new FMF sprouts, treatment with colchicine was restarted and a genetic study was performed which showed the M694 V mutation in MEFV genes.
In addition, due to the existence of a NS, a renal biopsy was performed, which showed amorphous deposits at glomerular and vascular levels on optical microscopy.
The deposits were congo red positive.
Electronic fixation revealed the presence of randomly oriented, non-branched 8-10 nmfiles, characteristic of amyloidosis.
After establishing the diagnosis of NS secondary to SA, the dose of colchicine increased to 1 mg/12 h and enalapril was started to try to reduce proteinuria.
With these measures, the patient developed hypotension and deteriorated renal function, so enalapril was discontinued.
Due to worsening NS, with the need to increase the dose of diuretics to control edema, in February 2011, it was decided to start treatment with anakinra at a dose of 100 mg/day.
As shown in Figure 1, proteinuria decreased from the second month of treatment and at the fifth month the patient already had partial remission of NS.
Complete remission of NS was achieved at 30 months of treatment (proteinuria < 0.5 g/day).
At the last visit (42 months after the start of anakinra), proteinuria was 0.4 g/day, serum creatinine was 1.18 mg/dl and serum albumin was 4 g/dl. The patient had no new FMF.
The patient has not experienced any adverse effects with anakinra treatment.
