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. Discussion 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.