Intest Res.  2018 Jan;16(1):151-154. 10.5217/ir.2018.16.1.151.

Duodenal amyloidosis secondary to ulcerative colitis

• Park SW
• Jee SR
• Kim JH
• Lee SH
• Hwang JW
• Jang JG
• Lee DW
• Seol SY

• KMID: 2402660
• DOI: http://doi.org/10.5217/ir.2018.16.1.151

Abstract

Amyloidosis is defined as the extracellular deposition of non-branching fibrils composed of a variety of serum-protein precursors. Secondary amyloidosis is associated with several chronic inflammatory conditions, such as rheumatologic or intestinal diseases, familial Mediterranean fever, or chronic infectious diseases, such as tuberculosis. Although the association of amyloidosis with inflammatory bowel disease is known, amyloidosis secondary to ulcerative colitis (UC) is rare. A 36-year-old male patient with a 15-year history of UC presented with nausea, vomiting, and abdominal pain. He had been treated with infliximab for 6 years. At the time of admission, he had been undergoing treatment with mesalazine and adalimumab since the preceding 5 months. Esophagogastroduodenoscopy showed mucosal erythema, edema, and erosions with geographic ulcers at the 2nd and 3rd portions of the duodenum. Duodenal amyloidosis was diagnosed using polarized light microscopy and Congo red stain. Monoclonal gammopathy was not detected in serum and urine tests, while the serum free light chain assay result was not specific. An increase in plasma cells in the bone marrow was not found. Secondary amyloidosis due to UC was suspected. The symptoms were resolved after glucocorticoid therapy.

Keyword

Amyloidosis; Colitis, ulcerative; Duodenum

MeSH Terms

Abdominal Pain
Adalimumab
Adult
Amyloidosis*
Bone Marrow
Colitis, Ulcerative*
Communicable Diseases
Congo Red
Duodenum
Edema
Endoscopy, Digestive System
Erythema
Familial Mediterranean Fever
Humans
Inflammatory Bowel Diseases
Infliximab
Intestinal Diseases
Male
Mesalamine
Microscopy, Polarization
Nausea
Paraproteinemias
Plasma Cells
Tuberculosis
Ulcer*
Vomiting
Adalimumab
Congo Red
Infliximab
Mesalamine

Figure

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  Fig. 1 Endoscopic findings. Mucosal edema, erythema, erosions, and geographic ulcers were observed at the (A) duodenal A B 2nd portion and (B) 3rd portion.

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  Fig. 2 Histologic findings. (A) Pink, amorphous hyaline materials were present in the mucosa and submucosa of the duodenum (H&E, ×100). (B) Polarized light microscopy using Congo red staining indicated the presence of amyloid deposits that exhibited apple-green birefringence (×100).

• 

  Fig. 3 On follow-up endoscopy, the mucosal edema, erosion, and geographic ulcers of the duodenum showed significant improvement.

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