Gastrointestinal amyloidosis secondary to chronic tophaceous gout / 대한내과학회지

ABSTRACT

Secondary amyloidosis is associated with infectious, inflammatory, or neoplastic disorders. Gouty arthritis, unlike other forms of chronic inflammatory arthritis, is not usually associated with amyloidosis. A 70.year.old man was admitted because of generalized edema, anorexia, and diarrhea. He had been diagnosed with gouty arthritis 12 years earlier and took over-the-counter medication during acute attacks. The physical examination revealed multiple tophi on his ears, right hand, and right foot. No evidence of amyloidosis involving the heart or bone marrow was detected. Biopsy of the antrum, duodenum, ileum, and descending colon showed green birefringence with Congo red stain. Immunohistochemistry was strongly positive for amyloid A. We diagnosed him as having secondary gastrointestinal amyloidosis AA with chronic tophaceous gouty arthritis. Allopurinol was administered and oral rednisolone was increased. However, he died from septic shock 25 days after admission.