Crohn's Disease and Secondary Amyloidosis: Early Complication? A Case Report and Review of the Literature

Abstract

Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease (IBD), generally seen in Crohn's disease. At least 1% of patients with Crohn's disease develop amyloidosis. In the literature, the time lapse between the onset of Crohn's disease and the diagnosis of amyloidosis has been reported to range from one to 21 years. In most patients, proteinuria heralded the onset of renal involvement from amyloid and occurred from three to 15 years after Crohn's disease diagnosis. In this case, we estimate secondary amyloidosis occurred before Crohn's disease or early Crohn's disease complication, based on the fact that hypoalbuminaemia and proteinuria was detected approximately one year after the start of gastrointestinal complaints.

Renal insufficiency in IBD — Prevalence and possible pathogenetic aspects

“…9,[21][22][23][24][25] There are many case reports on amyloidosis, but reviewing the literature the overall prevalence in IBD seems to be below 1%. 9,21,22 Glomerulonephritis has recently emerged as an extraintestinal manifestation and seems to be very rare with about 40 reports in the literature; it appears to be linked to disease activity as renal function improves after remission of IBD. 9,23,24 Tubulointerstitial nephritis seems to be a common clinical feature among IBD patients, manifesting with proteinuria.…”

Systematic review: the epidemiology of the hepatobiliary manifestations in patients with inflammatory bowel disease

“…Amyloidosis can appear early in the history of CD, sometimes before diagnosis of CD is made, or years after initial digestive symptoms . Mortality is almost related to renal failure, Wester et al .…”

Secondary Amyloidosis in a Patient with Long Duration Crohnʼs Disease Treated with Infliximab

“…[3] Nevertheless, there are case reports in which amyloidosis is an early initial complication of Crohn's disease. [4] Our case raises the question of how the 'traditional' markers of inflammation could have underestimated the inflammatory burden, as CRP had been below 3 mg dL and colonoscopies had shown mild inflammatory activity in the past 9 years. The reliability of CRP as a marker for inflammation was recently questioned when it was shown that a subset of patients with normal CRP values sometimes had significant mucosal lesions.…”