Adalimumab for AA Amyloidosis Secondary to Severe Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) (Verneuil's disease) is a chronic inflammatory cutaneous disorder with systemic inflammatory potential. A rare and severe sequela of this sustained inflammation is reactive (AA) amyloidosis, typically presenting with nephrotic-range proteinuria and progressive renal failure. Here, we report a 50-year-old male with severe (Hurley Stage III) HS who developed nephrotic syndrome secondary to biopsy-proven renal AA amyloidosis. Initiation of the TNF-α inhibitor adalimumab induced a dramatic concurrent improvement in both cutaneous and renal disease activities. Proteinuria declined from a baseline of 9/24 to 2 g/24 h at 4 months and subsequently to 0.9 g/24 h at 10 months, signifying a near-complete nephrotic remission.

This case underscores the dual therapeutic mechanism of TNF-α blockade in this context: reducing systemic inflammation and preventing amyloid deposition, with improvement in renal prognosis. There is literature corroborating the usefulness of TNF-α inhibitors in early-stage AA amyloidosis. The application of adalimumab early in severe forms of HS may avert AA amyloidosis-related renal involvement or renal function decline. We suggest implementing systematic screening for significant proteinuria in patients with advanced HS (Hurley II/III) to facilitate timely diagnosis and therapeutic intervention to preserve renal function.