Thread by @UTSWIMchief

Tough case of a man with a hx of drug use and skin popping who presented with anasarca. @DinoKazi providing mentorship and pearls throughout

For pitting edema: there's generally an issue with :
⬆️Hydrostatic pressure
⬇️Plasma oncotic pressure
🔥Vessel wall inflammation

Non-pitting edema is usually caused by:
🍗increased protein secretion in the interstitium(i.e myxedema)
🚧some issue with lymphatic drainage

This gentleman had pitting edema so the #virtualmorningreport team thought about cardiac, liver or renal etiologies... TL;DR, he was found to have:

🍔Nephrotic Syndrome..

We then had to figure out why!

He had normal complements, no + serology so the team pursued a biopsy which revealed....

AA Amyloid -> Nephrotic Syndrome!

AA amyloid is made up of "Serum Amyloid A" which is produced during inflammation. Over time and with high concentration this serum amyloid A can congregate and misfold -> deposition

MOST AA amyloid presents with renal manifestations, though occasionally other organs like the GI tract, Liver or thyroid can have clinical manifestations.

How do you treat?

🌊Stop the inflammation!

A cool study from @NEJM found that reducing the serum AA amyloid levels over time could results in regression of disease!

We learn the most from the diagnoses we don't catch at first!
1. Consider AA amyloid in:
🪲Chronic infection
🔥Chronic Inflammation/Rheum disease
2. Get a biopsy to confirm Dx
3. Control the inflammation!

#MedTwitter #medstudenttwitter #meded

Which diagnoses in medicine have humbled you the most?
@BrunoAlvCon @Kayla_KAR @CBergstromMD @CWashingtonMD @StephenGPhilip @bonnrx @dhjutsw1 @TimothyJBrownMD @InternFrench @NickLeeMD @EmmGeezee @DinoKazi @DrJulieTMD @BradCutrellMD