AA Amyloidosis Secondary to Horton's Disease Complicated by Pulmonary Fibrosis: A Very Challenging Diagnosis and Therapy
M. Njie *
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
P. M. Mulendelé
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
O. Mokni
Department of Cardiology, PH, CH Jacques Monod, Normandie, France.
M. Sidi Boutar
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco.
M. Haboub
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Department of Cardiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
S. Arous
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Department of Cardiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
M. Ghali Benouna
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Department of Cardiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
A. Drighil
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Department of Cardiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
L. Azzouzi
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Department of Cardiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
R. Habbal
Department of Cardiology P37, Ibn Rochd University Hospital, Casablanca, Morocco and Department of Cardiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
AA amyloidosis is a classic and serious complication of many chronic inflammatory processes, whether of infectious, autoimmune, or neoplastic origin. It is frequently complicated by kidney damage, often in the form of a nephrotic syndrome. Giant cell arteritis is a common inflammatory arteritis in the elderly; however, it rarely causes AA amyloidosis. We report a rare case of Horton disease causing AA amyloidosis in an elderly patient with history of myopericarditis and repeated episodes of congestive heart failure. Patient was treated initially with dual therapy based on corticosteroids and anti TNF therapy (Tocilizumab) associated with heart failure therapy recommended by the European society of cardiology (ESC 2021 guidelines on Heart Failure). The initial outcome was favorable but later complicated by the involvement of the lungs; pulmonary fibrosis, responsible for repeated episodes of pleural effusion non controlled in spite of high dose of loop diuretics and repeated pleural punction. Patient died shortly after her second hospitalization due to respiratory insufficiency.
Keywords: Horton disease, AA amyloidosis, pulmonary fibrosis, Cardiac MRI, corticosteroids and Tocilizumab