Korean J Gastroenterol.  2012 Jan;59(1):44-47. 10.4166/kjg.2012.59.1.44.

A Case of Primary Colon Amyloidosis Presenting as Hematochezia

• Kwon YH
• Kim JY
• Kim JH
• Park HW
• Yang HM
• Jeon SW
• Kim SK

• KMID: 1775832
• DOI: http://doi.org/10.4166/kjg.2012.59.1.44

Abstract

Amyloidosis is characterized by a deposition of insoluble fibrils in various organs and tissues. Amyloid deposition, in the gastrointestinal track, provokes a dysfunction of the organ, due to an accumulation of fibrils, and causes a variety of clinical symptoms and endoscopic findings. Primary amyloidosis in the gastrointestinal tract is rarely reported in Korea. We experienced a case of recurrent intestinal bleeding, in a 59-year-old female patient with primary amyloidosis. A colonoscopy revealed the presence of multiple large circular ulcers. In the entire colon, diffuse nodular lesions with edema and bleeding were found. A colonoscopic biopsy established the diagnosis of amyloidosis, to the exclusion of other disease components. We concluded that the patient had localized amyloidosis. Though a definitive therapeutic strategy has not been established for localized gastrointestinal amyloidosis, the patient has been successfully treated with a high-dose of steroids and azathioprine.

Keyword

Amyloidosis; Gastrointestinal hemorrhage; Colon

MeSH Terms

6-Mercaptopurine/analogs & derivatives/therapeutic use
Amyloidosis/*diagnosis/drug therapy/pathology
Antimetabolites/therapeutic use
Colon/pathology
Colonoscopy
Female
Gastrointestinal Hemorrhage
Humans
Middle Aged
Steroids/therapeutic use
Tomography, X-Ray Computed

Figure

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  Fig. 1 Abdominal CT findings. It demonstrated diffuse mural thickening in the ascending colon, transverse colon and descending colon.

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  Fig. 2 Colonoscopic findings. (A) It demonstrated diffuse nodular lesions with bleeding and friability at the ascending colon. (B) It demonstrated multiple irregular large ulcers with nodular lesions at the descending colon.

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  Fig. 3 Microscopic findings (Congo-red stain, ×100). (A) Congo-red stain revealed pink red deposits in the lamina propria of the colon. (B) The yellow-green birefringence of the deposits was observed by polarizing microscope.

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  Fig. 4 Colonoscopic findings. Follow-up colonoscopy demonstrated improvement of diffuse nodular lesions and ulceration at the entire colon.

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