Korean J Gastroenterol.  2012 Sep;60(3):172-176. 10.4166/kjg.2012.60.3.172.

Intestinal Amyloidosis with Intractable Diarrhea and Intestinal Pseudo-obstruction

• Kim YJ
• Kim HS
• Park SY
• Park SW
• Choi YD
• Park CH
• Choi SK
• Rew JS

• KMID: 1389726
• DOI: http://doi.org/10.4166/kjg.2012.60.3.172

Abstract

We report herein a case of intestinal amyloidosis with grave prognosis that caused intractable diarrhea and intestinal pseudo-obstruction, alternately in spite of intensive conservative treatment. A 44-year-old woman was admitted for fever, diarrhea, and crampy abdominal pain which had been continuned during 6 months. Abdomen CT scan showed edematous wall thickening of the small bowel and right colon, and colonoscopic biopsy revealed amyloid deposition in the mucosa. Monoclonal light chains in serum and/or urine were not detected and highly elevated serum amyloid A was shown. In spite of intensive treatment including oral prednisolone and colchicine, diarrhea and intestinal pseudo-obstruction developed alternately, general status rapidly got worsened and died after two months.

Keyword

Amyloidosis; Diarrhea; Intestinal pseudo-obstruction

MeSH Terms

Administration, Oral
Adult
Amyloidosis/complications/*diagnosis/drug therapy
Anti-Inflammatory Agents/therapeutic use
Colchicine/therapeutic use
Colonoscopy
Diarrhea/*etiology
Female
Humans
Intestinal Mucosa/pathology
Intestinal Pseudo-Obstruction/*diagnosis/etiology
Prednisolone/therapeutic use
Serum Amyloid A Protein/metabolism
Tomography, X-Ray Computed
Tubulin Modulators/therapeutic use

Figure

• 

  Fig. 1 Abdominal CT finding. Abdomen CT scan showed edematous wall thickening and mural enhancement of the pelvic small bowel loop and increased vascularity of the corresponding mesentery, mild edematous wall thickening of the colonic loop.

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  Fig. 2 Colonoscopic findings. Colonoscopy showed diffusely distributed petechial mucosal suggillations in the ascending colon (A) and shallow erosions in the terminal ileum (B).

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  Fig. 3 Microscopic findings. (A) Eosinophilic proteineous material deposition was identified in the lamina propria of the colonic mucosa (H&E, ×100). (B) This material resulted in a positive reaction using the Congo red stain (×200).

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  Fig. 4 Endoscopic findings. Endoscopic examinations revealed various findings such as diffuse geographic ulcerations (A), small healing ulcers or erosions (B), yellowish exudate coated hyperemic mucosal lesions (C) and mucosal and submucosal hemorrhagic spots (D).

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