Abstract: TH-PO0922
A Case of Amyloid Arthritis with Increased Amyloid Deposition of Both β2-Microglobulin and Transthyretin Before Reinitiating Dialysis Long After Kidney Transplantation
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Minami, Yuki, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Ueki, Kenji, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Yamada, Shunsuke, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Torisu, Kumiko, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Ago, Tetsuro, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
- Nakano, Toshiaki, Kyushu Daigaku Igakubu Daigakuin Igakukei Gakufu Daigakuin Igaku Kenkyuin, Fukuoka, Fukuoka Prefecture, Japan
Introduction
Dialysis-related amyloidosis, caused by β2-microglobulin (β2MG), is a known complication in dialysis patients. Transthyretin (TTR) amyloidosis primarily affects the heart but may also involve joints. However, joint amyloid involving both β2MG and TTR has not been previously documented. We report a unique case occurring during a period off dialysis following kidney transplantation.
Case Description
A 65-year-old man had been on dialysis for 29 years before receiving a deceased-donor kidney transplant. Fourteen years post-transplant, he developed unexplained cardiac dysfunction, prompting myocardial biopsy, which led to the diagnosis of wild-type TTR cardiac amyloidosis. His renal function gradually worsened, and 17 years after transplantation, he resumed dialysis due to graft failure. He then developed persistent fever without clear cause. Laboratory workup ruled out infection or autoimmune disease. CT revealed periarticular masses in shoulders and hips; gallium scintigraphy showed uptake at the same sites. CT-guided biopsy of a shoulder mass demonstrated amyloid deposition. Immunostaining and mass spectrometry confirmed both β2MG and TTR. Treatment with glucocorticoids, tafamidis, and β2MG adsorption therapy resulted in resolution of fever. He remained afebrile for over one year with improved inflammatory markers.
Discussion
This case is the first reported instance of amyloid arthritis involving both β2MG and TTR in a dialysis patient. It also demonstrates that β2MG amyloid deposition can progress during kidney dysfunction, even in the absence of dialysis treatment. TTR amyloidosis, a treatable condition, should be considered as a possible cause of unexplained fever or heart failure in dialysis patients. This case highlights the importance of combining immunostaining for non-β2MG amyloids, including TTR, with mass spectrometry for accurate diagnosis and appropriate therapeutic decision-making.
CT at kidney transplant (A) and present admission (B). Gallium scintigraphy (C). Shoulder joint biopsy (D–F).