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Diana Silva1, Tiago Silva1, Maria João Brito1, Gisela Neto2, Pedro Jordão3, Catarina Gouveia1

1 - Pediatric Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
2 - Pediatric Nephrology Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
3 - Pediatric Orthopedic Unit; Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal.

- 38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2020)
- International meeting, online conference
- E-poster

Background: Complications can develop when patients with prolonged chronic diseases have been subjected to inadequate, or even unknown, treatment. This can make patient management even more challenging. Osteomyelitis is an example of a disease whose diagnosis is complex. The treatment is difficult to achieve, requiring long term antibiotic therapy. Nonetheless, it has a high morbidity rate, especially if not properly treated.
Case Presentation: Fifteen years-old male from Angola, newly arrived to Portugal, with a history of tuberculosis (TB) allegedly treated. He presented draining fistulas and edema in his left thigh. He also complained of weight loss and a cervical mass. Facial edema and high blood pressure were presented and complementary exams revealed nephrotic-range proteinuria, microcytic hypochromic anaemia, thrombocytosis, high sedimentation rate (92mm/h), C-reactive protein (61.1mg/dL) and high serum creatinine levels (1.04 mg/dL). The lower limb CT showed chronic femur osteomyelitis. Due to MRSA isolation, he was treated with linezolid, debridement and antibiotic impregnated femoral intramedullary nail. Additionally, IGRA was positive and the thorax CT showed a right hilar adenopathy with calcifications. Since the previous treatment was unknown, TB was assumed and started anti-TB therapy. The renal ultrasound revealed an increased echogenicity of the kidney parenchyma and reduced corticomedullary differentiation, in favour of nephropathy. Afterwards, the renal biopsy clarified the presence of amyloid deposits, secondary to a chronic inflammation process.
Learning Points/Discussion: Amyloidosis results from the accumulation of pathogenic amyloids in different tissues. Although rare, amyloidosis can occur, and is usually caused by chronic inflammation. In the presented case, it is likely that chronic osteomyelitis and untreated TB might have played a role. This highlights the importance of connecting all data to reach a diagnosis and the best treatment for each patient.

Palavras Chave: Amyloidosis, chronic osteomyelitis, tuberculosis