A previously healthy 52 year-old woman presented with a three month history of progressive abdominal bloating, nausea, vomiting, diarrhea, anorexia and weight loss following a recent trip to Venezuela. Initial investigations at the time of her presentation revealed leukocytosis and elevated alkaline phosphatase. Stool cultures for ovum and parasite, Clostridium difficile toxin were negative. Computed tomography of the abdomen was unremarkable. Three months after the onset of symptoms, there was progressive deterioration of her clinical status, and she was admitted for further investigations. This included an abdominal ultrasound which revealed hepatosplenomegaly and ascites and nephrotic range proteinuria. The patient also underwent upper and lower endoscopy which revealed diffuse patchy inflammation and mucosal friability throughout the stomach, duodenum, terminal ileum and colon. Initial biopsy results suggested a non-specific inflammatory process but subsequently revealed negative birefringence and positive Congo red staining, confirming the diagnosis of primary amyloidosis resulting from multiple myeloma. The endoscopic and pathologic findings noted in this case follow the pattern of amyloid deposition associated with multiple myeloma, as opposed to those observed in familial and secondary types of systemic amyloidosis. Therefore, the pattern of endoscopic involvement may be helpful in the diagnosis of the various types of systemic amyloidoses.

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