임파선 결핵에 동반된 유전분증 1 예

We experienced a rare case of amyloidosis associated with tuberculosis. A 34-year-old man in was admitted because of multiple lymphadenopathy, intermittent fever, and generalized weakness. He showed massive proteinuria, metabolic acidosis, low creatinine clearance and hematmesis. The cervical lymph node biopsy revealed chronic granuloma with multinucleated giant cell and caseous necrosis consistent with tuberculous lymphadenopathy, and also showed diffuse deposition of homogenous amorphous eosinophilic material. The percutaneous needle biopsy of kidney showed massive infiltration of pale pinkish amorphous material in the glomerular mesangium. Gastric mucosal biopsy revealed infiltration of amorphous material in the lamina propria. Polarizing illumination after Congored staining on all the three tissue biopsy showed typical green birefringence. A computerized tomographic (CT) scan of the abdomen showed hepatosplenomegaly and both renal vein thrombosis. He was managed with peritoneal dialysis, anti-TBc medication, steroids and other supportive measures. Despite aggressive treatment, his condition deteriorated day by day. He was discharged with hopeless condition. This case indicated that we should not exclude a possibility of the secondary amyloidosis in case of tuberculosis and massive proteinuria. To our knowledge, we think that this case is the first case of amyloidosis associated with tuberculosis in Korea.