The Masquerading Bleed
2008; Lippincott Williams & Wilkins; Volume: 103; Linguagem: Inglês
10.14309/00000434-200809001-00844
ISSN1572-0241
AutoresNeil Sharma, Jonathan Keshishian, J. S. Johnson, Jeffery Kooper, Adel Daas, Donald Amodeo,
Tópico(s)Parathyroid Disorders and Treatments
ResumoPurpose: We report a case of anemia initially attributed to arteriovenous malformations and duodenitis. Further evaluation of the friable mucosa with endoscopy and biopsies revealed the true underlying diagnosis to be AL (Lambda) type Amyloidosis. Case Report: A 59 yo male with DM, CAD, and CKD presented to his PCP with a complaint of fatigue. He denied any gastroenterological complaints and was found to have a Hgb of 6.1 (g/dL) and was FOBT positive. On initial EGD, mild gastritis with a 2 or 3 AVMs were noted in the stomach along with a “friable” appearing duodenitis. The colonoscopy showed a few scattered submucosal hemorrhagic vessels. Since these limited findings did not explain the patient's degree of anemia, a capsule endoscopy was performed which showed angioectasias with limited active bleeding in the proximal jejunum and friable mucosa. Enteroscopy with biopsy of the distal duodenum and proximal jejunum was performed. There was significant oozing of the friable mucosa noted post biopsy. The biopsies were positive for Amyloidosis on Congo Red staining showing classic apple green birefringence. Fat pad biopsy was subsequently done and positive as well, with further staining confirming AL type. Renal and bone marrow biopsies were negative for Amyloidosis. The patient was referred to Oncology and was started on oral melphalan with high dose dexamethasone. Discussion: AL type Amyloidosis has an estimated incidence of 1 in 100,000 in Westernized countries, and its diagnosis upon biopsy from the gastrointestinal tract is even rarer. The presentation of acute on chronic anemia with no gastrointestinal complaints makes this case clinically unique.FigureFigure
Referência(s)