Gastric AA amyloidosis secondary to chronic infection presenting with hematemesis: a case report
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CASE REPORT
Gastric AA amyloidosis secondary to chronic infection presenting with hematemesis: a case report Yuting Huang1 · Salahuddin Nasir2 · Suryanarayana Reddy Challa1 · Carol Chiung‑Hui Peng1 · Kristen Stashek3 · Rachel Fanaroff3 · Shien Hu3 Received: 11 June 2020 / Accepted: 14 August 2020 © Japanese Society of Gastroenterology 2020
Abstract AA amyloidosis, previously known as secondary amyloidosis, has been associated with multiple chronic inflammatory conditions, including various autoimmune diseases and rarely chronic infection. Hereby, we present a case of AA amyloidosis secondary to chronic infection which initially presented with nausea and hematemesis. Endoscopic biopsies revealed diffuse AA amyloid deposition in the stomach, but not the esophagus. AA Amyloidosis presumably compromised gastric motility, promoted reflux related esophageal ulcers and erosions, and caused his cardiac and renal insufficiency. Therefore, endoscopic biopsies could be practical investigation to identify AA amyloidosis in the setting of chronic inflammatory diseases, especially with multi-organ involvement. Keywords AA amyloidosis · Hematemesis · GI amyloidosis · Chronic infection
Introduction Amyloidosis is an abnormal deposition of insoluble fibrillary amyloid protein that forms β-pleated sheets and exhibits apple-green birefringence in polarized microscopy with Congo red stain. It is formed from different precursor proteins, including AL (light chain), AA (apolipoprotein serum amyloid), β-2 amyloid (end-stage renal disease), ATTRm (mutated TTR protein) and ATTRwt (wild-type TTR monomers) [1]. Amyloidosis manifests as a systemic illness with the involvement of multiple organs, most commonly kidney, Yuting Huang, Salahuddin Nasir, and Suryanarayana Reddy Challa authors contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12328-020-01211-7) contains supplementary material, which is available to authorized users. * Shien Hu [email protected] 1
University of Maryland Medical Center Midtown Campus, 827 Linden Ave, Baltimore 21201, USA
2
American University of Antigua College of Medicine, Coolidge, Antigua and Barbuda
3
University of Maryland School of Medicine, Baltimore 21201, USA
along with heart, liver, spleen, thyroid, adrenals, and lymph nodes. About 3% of amyloidosis patients had biopsy-proven amyloid involvement of the gastrointestinal (GI) tract [2]. AA amyloidosis is more often related to rheumatoid arthritis, familial Mediterranean fever, ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel disease. We encountered a case presented with repeated hematemesis, proven to have AA amyloidosis by endoscopic biopsy and amyloid typing. The patient had classic multisystem amyloidosis, which was secondary to his chronic inflammation from large sacral decubitus ulcer, osteomyelitis, and bilateral above knee amputations complicated with infection.
Case presentation A 52-year-old African American male presented wi
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