Case of the Month: Celiac Disease and Secondary Amyloidosis: A Possible Causal Association?
Ankit Chhoda, MD, Deepanshu Jain, MD, Mradul Kumar Daga, MD, and Vineeta Batra, MD
ACG Case Rep J 2018;5:e24
Editor’s Commentary: The May Case of the Month discusses the methodic evaluation of nephrotic syndrome, including an infectious work-up, autoimmune investigation, and renal biopsy. In this case, renal biopsy revealed AA amyloidosis as the cause, which is fitting given that AA amyloidosis most frequently involves the kidneys, typically leading to nephrotic syndrome. Upon finding AA amyloidosis, a complication of chronic inflammatory conditions, the authors describe the search for a primary inflammatory condition. They found an elevated anti-TTG antibody, prompting an endoscopic evaluation. EGD and biopsy results were consistent with celiac disease, which in combination with a positive serology, provided the presumptive diagnosis. While the patient died prior to confirming the diagnosis with a gluten-free diet, this case highlights the thought process needed to uncover several intricately connected diseases spanning multiple organ systems.
