RESUMO
Secondary amyloidosis is a well-established entity and has been described in association with chronic inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis, bronchiectasis, tuberculosis, etc., It has also been reported in association with neoplasms such as Hodgkin's lymphoma, Waldenstrom's macroglobulinemia, renal cell carcinoma, lung carcinoma, etc. However, only a few case reports documenting the association of amyloidosis with gastrointestinal tumor (GIST) and gastric adenocarcinoma are available in the literature. Hereby, we report a case of a 74-year-old male who presented with colicky abdominal pain and vomiting. Ultrasonography revealed a common bile duct (CBD) stone and a small extra-luminal gastric mass. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to remove the CBD stone which revealed an incidental finding of gastric ulcer. A biopsy was taken from the gastric ulcer which on histopathological examination was confirmed as adenocarcinoma leading onto total gastrectomy. During total gastrectomy, an inadvertent injury to the spleen led to simultaneous splenectomy. Multiple samples from the gastric ulcer, the extra-luminal gastric mass, and the spleen were subjected to histopathological examination. Gastric ulcer was confirmed as adenocarcinoma, gastric extra-luminal mass was confirmed as GIST, and splenic examination revealed widespread deposition of amyloid which on Congo-red stain imparted an apple-green birefringence on polarizing microscopy. To the best of our knowledge, this is the first-ever case of such an association where gastric adenocarcinoma occurred with concomitant gastric GIST and secondary amyloidosis of the spleen.
RESUMO
BACKGROUND: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Secondary amyloidosis can occur as a complication of chronic systemic inflammatory and infectious diseases. Until now there has been no report of secondary amyloidosis associated with MS. We report herein a case of renal biopsy-proven secondary amyloidosis in a patient with MS. CASE REPORT: A 41-year-old woman with MS was hospitalized due to aggravated quadriparesis and edema in both lower extremities. Laboratory findings showed nephrotic-range proteinuria and hypoalbuminemia. A percutaneous renal biopsy procedure was performed, the results of which revealed secondary amyloid-A-type amyloidosis associated with MS. CONCLUSIONS: This is the first report of secondary amyloidosis associated with MS.
Assuntos
Adulto , Feminino , Humanos , Amiloidose , Biópsia , Sistema Nervoso Central , Doenças Transmissíveis , Doenças Desmielinizantes , Edema , Hipoalbuminemia , Extremidade Inferior , Esclerose Múltipla , Síndrome Nefrótica , Proteinúria , QuadriplegiaRESUMO
This paper describes the first case of common variable immunodeficiency (CVID) and AA amyloidosis. A recently treated tuberculosis, and chronic inflammation induced by frequent respiratory tract infections, were thought to be responsible for the amyloidosis. No other reason for this condition could be detected. Although T cell dysfunction in some CVID patients has been reported, pulmonary tuberculosis is quite rare with this condition. Bacterial or viral agents or evidence in favour of intestinal tuberculosis, which would explain this patient's recurrent diarrhea, were not found. In this case, the response of the attacks of diarrhea to metranidazole and the histologic observation of extensive intestinal amyloid deposition, which is known to decrease intestinal motility, made us conclude that the diarrhea was associated with bacterial overgrowth. In this report, we discuss the association of CVID and tuberculosis to secondary amyloidosis and recurrent diarrhea.
Assuntos
Masculino , Humanos , Adulto , Tuberculose/complicações , Diarreia/etiologia , Imunodeficiência de Variável Comum/complicações , Amiloidose/etiologiaRESUMO
Amyloidosis is a disease characterized by deposition of amorphous and insoluble fibrillar protein in various tissues and organs, but its productive mechanism has not been established yet. Enlargement and functional disturbance of infiltrated organs result in various clinical symptoms. Primary amyloidosis usually involve tongue, heart, nerve, gastrointestinal tract, ligament, skin, and bone marrow without underlying disease. Secondary amyloidosis is associated with chronic inflammatory disease such as tuberculosis, urogenital infection, rheumatoid arthritis, chronic ulcerative colitis, myelitis, 3rd syphilis and leprosy. The authors had experienced a case of secondary amyloidosis associated with rheumatoid arthritis, especially involving heart. He had suffered from rheumatoid arthritis for 17 years and admitted because of generalized edema and dyspnea. This case was confirmed by endomyocardial biopsy and immunohistochemical stain showed AA type. We treated him conservatively and he was transferred to other hospital on the 25th day of hospitalization but died suddenly after twelve hours.