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Unusual presentation of more common disease/injury
Primary systemic amyloidosis presenting as idiopathic inflammatory colitis
  1. Nadeem Rahman1,
  2. Muhammad Toqeer1,
  3. Ian Hawley2,
  4. Simon Weston-Smith3,
  5. Mark W Whitehead1,
  6. Johan Willem Rademaker1,
  7. Eric McWilliams4
  1. 1Department of Gastroenterology, Conquest hospital, St Leonards On Sea, UK
  2. 2Department of Histopathology, Conquest Hospital, St Leonards On Sea, UK
  3. 3Department of Haematology, Conquest Hospital, St Leonards on sea, UK
  4. 4Department of Cardiology, Conquest Hospital, St Leonards on Sea, UK
  1. Correspondence to Dr Nadeem Rahman, nadeemrahman{at}yahoo.com

Summary

A 75-year old-female was referred with chest pain. She was fully investigated and it was felt that her symptoms were non-cardiac. Four months later, she was seen in gastroenterology outpatients with bloody diarrhoea and abdominal pain. Colonoscopy demonstrated inflammation up to the splenic flexure and histology confirmed inflammatory colitis. Later, she developed dyspepsia and weight loss. An oesophagogastroduodenoscopy (OGD) showed Helicobacter pylori negative erosive gastritis with a benign duodenal ulcer. Whole body CT scan was normal. Ten months later, she was admitted with dyspnoea due to severe heart failure. The admission ECG had significantly changed, now showing low voltage complexes and repeat echocardiography showed restrictive cardiomyopathy. Specific congo red staining on the biopsy specimens from the previous OGD and colonoscopy confirmed amyloid deposits. Further investigations detected an underlying light chain myeloma causing systemic (AL) amyloidosis. Unfortunately, her condition deteriorated rapidly and she died shortly afterwards.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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