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Khedraki R, El-Roumi J, Allende D, Ives L, Garber A, RubioTapia A, Achkar JP, Cline M, Baggott B, Cohen B, Rieder F, Hanna M. Gastrointestinal Amyloid Screening Study (GASS): is screening for amyloid in the gastrointestinal tract useful? Amyloid 2024; 31:241-243. [PMID: 38771016 DOI: 10.1080/13506129.2024.2347493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Rola Khedraki
- Department of Cardiovascular Medicine, Scripps, La Jolla, CA, USA
| | - Joseph El-Roumi
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Daniela Allende
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Ives
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ari Garber
- Department of Gastroenterology, Cleveland Clinic, OH, USA
| | | | | | - Michael Cline
- Department of Gastroenterology, Cleveland Clinic, OH, USA
| | - Brian Baggott
- Department of Gastroenterology, Cleveland Clinic, OH, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Cleveland Clinic, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Cleveland Clinic, OH, USA
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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2
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Mirioglu S, Uludag O, Hurdogan O, Kumru G, Berke I, Doumas SA, Frangou E, Gul A. AA Amyloidosis: A Contemporary View. Curr Rheumatol Rep 2024; 26:248-259. [PMID: 38568326 PMCID: PMC11219434 DOI: 10.1007/s11926-024-01147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE OF REVIEW Amyloid A (AA) amyloidosis is an organ- or life-threatening complication of chronic inflammatory disorders. Here, we review the epidemiology, causes, pathogenesis, clinical features, and diagnostic and therapeutic strategies of AA amyloidosis. RECENT FINDINGS The incidence of AA amyloidosis has declined due to better treatment of the underlying diseases. Histopathological examination is the gold standard of diagnosis, but magnetic resonance imaging can be used to detect cardiac involvement. There is yet no treatment option for the clearance of amyloid fibril deposits; therefore, the management strategy primarily aims to reduce serum amyloid A protein. Anti-inflammatory biologic agents have drastically expanded our therapeutic armamentarium. Kidney transplantation is preferred in patients with kidney failure, and the recurrence of amyloidosis in the allograft has become rare as transplant recipients have started to benefit from the new agents. The management of AA amyloidosis has been considerably changed over the recent years due to the novel therapeutic options aiming to control inflammatory activity. New agents capable of clearing amyloid deposits from the tissues are still needed.
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Affiliation(s)
- Safak Mirioglu
- Division of Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Omer Uludag
- Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ozge Hurdogan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gizem Kumru
- Division of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ilay Berke
- Division of Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Stavros A Doumas
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Eleni Frangou
- Department of Nephrology, Limassol General Hospital, State Health Services Organization, Limassol, Cyprus
- University of Nicosia Medical School, Nicosia, Cyprus
| | - Ahmet Gul
- Division of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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3
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Rauf SA, Shah HH, Khatri R, Ul Haq M, Dave T, Ali JP, Ali SK. Gastrointestinal amyloidosis in a 50-year-old patient with miliary tuberculosis: A case report. Clin Case Rep 2024; 12:e8978. [PMID: 38799515 PMCID: PMC11126638 DOI: 10.1002/ccr3.8978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
This case highlights the importance of considering tuberculosis as an underlying cause of gastrointestinal amyloidosis, even in patients previously treated for the infection. Clinicians should maintain a high index of suspicion for atypical presentations of amyloidosis, especially in individuals with chronic inflammation, enabling early diagnosis and tailored management for improved patient outcomes. Abstract Gastrointestinal amyloidosis is a rare condition often associated with chronic inflammation. We present a unique case of a 50-year-old female with a history of miliary tuberculosis who developed gastrointestinal amyloidosis. The patient exhibited chronic loose stools, weight loss, abdominal pain, and urinary incontinence symptoms. Diagnostic workup revealed characteristic findings of amyloidosis on biopsy. Despite treatment for tuberculosis, her symptoms persisted, highlighting the challenging nature of managing this condition. This case underscores the importance of considering tuberculosis as a potential cause of secondary amyloidosis in patients with ongoing symptoms of inflammation and infection. Early recognition and tailored management are crucial in optimizing patient outcomes.
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Affiliation(s)
- Sameer Abdul Rauf
- Department of Internal MedicineLiaquat National Hospital and Medical CollegeKarachiPakistan
| | - Hussain Haider Shah
- Department of Internal MedicineDow University of Health SciencesKarachiPakistan
| | - Rahul Khatri
- Department of Internal MedicineLiaquat National Hospital and Medical CollegeKarachiPakistan
| | - Mansoor Ul Haq
- Department of GastroenterologyLiaquat National Hospital and Medical CollegeKarachiPakistan
| | - Tirth Dave
- Bukovinian State Medical UniversityChernivtsiUkraine
| | - Javaria Parwez Ali
- Department of HistopathologyLiaquat National Hospital and Medical CollegeKarachiPakistan
| | - Syed Khizar Ali
- Department of Internal MedicineLiaquat National Hospital and Medical CollegeKarachiPakistan
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4
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Ye XY, Guan Y, Yuan J. An Unusual Cause of Cat Scratch Colon. Gastroenterology 2024:S0016-5085(24)00421-9. [PMID: 38631417 DOI: 10.1053/j.gastro.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Xiao Yan Ye
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yue Guan
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jie Yuan
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
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5
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Asaad A, Ranjous Y, Hassan ZA, Alahmad N, Ghanimeh L, Ali A. Chronic underlying gastrointestinal amyloidosis was revealed by cardiac echography: a case report from Syria. Ann Med Surg (Lond) 2024; 86:2253-2255. [PMID: 38576978 PMCID: PMC10990300 DOI: 10.1097/ms9.0000000000001901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Amyloidosis is an infiltrative disease caused by the deposition of abnormal proteins. While cardiac amyloidosis is relatively common, gastrointestinal (GI) tract involvement is less frequent. In this case, the authors report a delayed diagnosis of systemic amyloidosis presenting mainly with digestive symptoms. Case presentation An 81-year-old male presented with the complaint of persistent diarrhoea for over a year and the progressive development of edemas during the last 4 months. Echocardiogram findings revealed the presence of the characteristic sparkling sign. The diagnosis of amyloidosis was confirmed by histopathological biopsies taken from the duodenum. Serum electrophoresis findings strongly suggested the possibility of plasma cell dyscrasia. Clinical discussion What distinguishes this case is that the suspicion of amyloidosis as the underlying cause of the diarrhoea did not arise until an incidental echocardiogram revealed cardiac hypertrophy and a sparkling appearance. Conclusion This case reminds us to consider amyloidosis as a possible underlying cause for unexplained gastrointestinal symptoms such as diarrhoea, especially in bad economic situations where the diagnosis of rare diseases may be delayed.
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Affiliation(s)
| | - Yahia Ranjous
- Department of Gastroenterology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Zein Aldeen Hassan
- Department of Gastroenterology, Faculty of Medicine, Damascus University, Damascus, Syria
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Akharume O, Ojeniyi S, Naqvi HA. Systemic Amyloid A Protein Amyloidosis With Gastrointestinal Involvement. ACG Case Rep J 2024; 11:e01311. [PMID: 38560020 PMCID: PMC10980407 DOI: 10.14309/crj.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Systemic amyloidosis is a multiorgan deposition of misfolded amyloid protein fibrils. The systemic amyloid A protein (AA) amyloidosis type predominantly involves the kidney and is mostly an under-recognized complication among persons who inject drugs. Gastrointestinal involvement in systemic AA amyloidosis that is associated with illicit drug use is uncommon. In this report, we present a case of a 40-year-old man with history of injection drug use, recurrent skin and soft-tissue infection, and renal AA amyloidosis that presented with painless bloody bowel movement, which initially resolved with conservative management. Upon further evaluation, the patient was found to have empyema that required antibiotic therapy and bilateral pleural drain. His hospital course was further complicated by multiple episodes of hematochezia requiring gastrointestinal consultation. Subsequent gastrointestinal biopsy revealed amyloid deposit.
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Affiliation(s)
- Olubunmi Akharume
- Department of Medicine, Medstar Union Memorial Hospital and Medstar Franklin Square Medical Center, Baltimore, MD
| | - Solabomi Ojeniyi
- Department of Medicine, Medstar Union Memorial Hospital and Medstar Franklin Square Medical Center, Baltimore, MD
| | - Haider A. Naqvi
- Department of Medicine, Medstar Union Memorial Hospital and Medstar Franklin Square Medical Center, Baltimore, MD
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Habib MH, Tiger YKR, Dima D, Schlögl M, McDonald A, Mazzoni S, Khouri J, Williams L, Anwer F, Raza S. Role of Palliative Care in the Supportive Management of AL Amyloidosis-A Review. J Clin Med 2024; 13:1991. [PMID: 38610755 PMCID: PMC11012321 DOI: 10.3390/jcm13071991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Light chain amyloidosis is a plasma-cell disorder with a poor prognosis. It is a progressive condition, causing worsening pain, disability, and life-limiting complications involving multiple organ systems. The medical regimen can be complex, including chemotherapy or immunotherapy for the disease itself, as well as treatment for pain, gastrointestinal and cardiorespiratory symptoms, and various secondary symptoms. Patients and their families must have a realistic awareness of the illness and of the goals and limitations of treatments in making informed decisions about medical therapy, supportive management, and end-of-life planning. Palliative care services can thus improve patients' quality of life and may even reduce overall treatment costs. Light chain (AL) amyloidosis is a clonal plasma cell disorder characterized by the excessive secretion of light chains by an indolent plasma cell clone that gradually accumulates in vital organs as amyloid fibrils and leads to end-organ damage. With progressive disease, most patients develop diverse clinical symptoms and complications that negatively impact quality of life and increase mortality. Complications include cardiac problems including heart failure, hypotension, pleural effusions, renal involvement including nephrotic syndrome with peripheral edema, gastrointestinal symptoms leading to anorexia and cachexia, complex pain syndromes, and mood disorders. The prognosis of patients with advanced AL amyloidosis is dismal. With such a complex presentation, and high morbidity and mortality rates, there is a critical need for the establishment of a palliative care program in clinical management. This paper provides an evidence-based overview of the integration of palliative care in the clinical management of AL amyloidosis as a means of reducing ER visits, rehospitalizations, and in-hospital mortality. We also discuss potential future collaborative directions in various aspects of clinical care related to AL amyloidosis.
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Affiliation(s)
- Muhammad Hamza Habib
- Department of Palliative Care, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, USA
| | - Yun Kyoung Ryu Tiger
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Danai Dima
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Mathias Schlögl
- Department of Geriatric Medicine, Clinic Barmelweid, 5017 Barmelweid, Switzerland;
| | - Alexandra McDonald
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Sandra Mazzoni
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Jack Khouri
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Louis Williams
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Faiz Anwer
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
| | - Shahzad Raza
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (D.D.); (A.M.); (S.M.); (J.K.); (L.W.); (F.A.); (S.R.)
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8
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Jarava Delgado M, Gómez Torres KM, Gallardo Sánchez F. Beyond digestive pathology: endoscopic study in systemic disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38469812 DOI: 10.17235/reed.2024.10324/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
A 77-year-old male patient with heart disease, kidney disease under study, and quiescent multiple myeloma. He presented a 2 years history of weight loss and digestive symptoms. In the endoscopic study, multiple gastric ulcers were observed, whose histological study ruled out the initial suspicion. The patient died a month later from refractory shock.
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9
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Harris JC, Zhang Q, Tondon R, Alipour Z, Stashek K. Characterization of Amyloidosis in the Gastrointestinal Tract With an Emphasis on Histologically Distinct Interstitial Patterns of Deposition and Misinterpretations. Am J Surg Pathol 2024; 48:302-308. [PMID: 38145407 DOI: 10.1097/pas.0000000000002173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Amyloidosis can involve the gastrointestinal (GI) tract, and deposition can present with varied histologic patterns that make recognition challenging. This retrospective observational study aimed to characterize the deposition patterns in the GI tract and evaluate key quality metrics, including discrepant cases, to improve recognition and provide insight for accurate diagnosis. Sixty-two patients (195 biopsies) with amyloid involvement of the luminal tract were reviewed. Amyloid subtyping by mass spectrophotometry was available for 59 patients. Immunoglobulin light chain (AL) was the most commonly identified subtype (60%), followed by serum amyloid A (AA; 19%) and transthyretin (ATTR; 16%). 150/195 biopsies (77%) were positive for amyloid deposition, with an average of 2.4 positive biopsies per every 3.1 taken per patient. The sites with the highest yield were duodenum (37/37, 100%) and colon (63/74, 85%). Gastric biopsies were most likely to involve the lamina propria (41/45, 91%, P < 0.001), with the background mucosa showing reactive epithelial changes in almost half of the biopsies (20/45, 44%). Several distinct histologic patterns of interstitial deposition were identified, including muscularis mucosae deposition (n = 40, 27% of positive biopsies), peri-Brunner gland (n = 6, 17% of duodenal biopsies), mass-forming (n = 4, 2.7% of positive biopsies, including 3 suspected cases with localized involvement), collagenous colitis-like (n = 3, 4.8% of positive colonic biopsies), and globular (n = 19, 12.7% of positive biopsies). Congo Red was ordered in 81% of cases in which it was requested clinically, with a positivity rate of 30%. Of the 34 cases in which an amyloid workup was requested (but Congo Red was not performed), 14 were positive on reevaluation. Several missed cases had deposition in multiple biopsies, and almost half were missed by subspecialist GI pathologists. Nine misinterpretations were from the stomach, with seven initially diagnosed as chemical or reactive gastropathy. Additional discrepant cases were identified from the duodenum (n = 2) and colon (n = 3), with the vascular-only deposition pattern (n = 3), muscularis mucosae-only deposition (n = 3), and globular pattern (n = 1) identified. Given the challenges of identifying amyloid on hematoxylin and eosin staining, Congo Red ordering percentage should be 100% in clinically suspicious cases unless deposition is definitively seen on hematoxylin and eosin staining.
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Affiliation(s)
- Jaryse Carol Harris
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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10
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Bathobakae L, Ansari N, Mahmoud A, Hasan S, Yuridullah R, Qayyum S, Rae S. Gastric, Colonic, and Rectal Amyloidosis in the Setting of Familial Mediterranean Fever: A Unique Cause of Intractable Diarrhea. Case Rep Gastrointest Med 2024; 2024:6679725. [PMID: 38292345 PMCID: PMC10827378 DOI: 10.1155/2024/6679725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/11/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
Familial Mediterranean fever (FMF) is a hereditary disorder characterized by episodes of fever, polyserositis, or cutaneous inflammation. The FMF attacks last 1-3 days and have no apparent triggers. Recurrent deposition of the serum amyloid A (SAA) protein in the gut can cause intractable diarrhea, dysmotility, and recurrent abdominal pain. Gastrointestinal amyloidosis is a rare, but serious, complication of FMF. In this case report, we describe a rare case of chronic diarrhea and recurrent abdominal pain due to FMF-induced gastrointestinal amyloidosis.
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Affiliation(s)
- Lefika Bathobakae
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Nida Ansari
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Shayee Hasan
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Ruhin Yuridullah
- Gastroenterology and Hepatology, St. Joseph's University Medical Center, Paterson, USA
| | - Sohail Qayyum
- Pathology and Lab Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Sam Rae
- Nephrology Division, St. Joseph's University Medical Center, Paterson, USA
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11
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Ramachandran R, Grantham T, Isaac-Coss G, Etienne D, Reddy M. Gastroduodenal Involvement in AL Amyloidosis: Case Report and Literature Review. J Investig Med High Impact Case Rep 2024; 12:23247096241237759. [PMID: 38462925 PMCID: PMC10929022 DOI: 10.1177/23247096241237759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/12/2024] Open
Abstract
Gastrointestinal amyloidosis is a rare condition commonly found in the setting of systemic AL amyloidosis. Amyloid can deposit throughout the gastrointestinal tract and the resulting symptoms vary depending on the site of deposition. Gastrointestinal (GI) manifestations can range from weight loss or abdominal pain, to more serious complications like gastrointestinal bleeding, malabsorption, dysmotility, and obstruction. This case describes a patient with known history of IgG lambda AL amyloidosis, presenting with epigastric pain and unintentional weight loss found to have gastroduodenal amyloidosis. The definitive diagnosis of GI amyloidosis requires endoscopic biopsy with Congo red staining and visualization under polarized light microscopy. There are currently no specific guidelines for the management of GI amyloidosis. Generally, the goal is to treat the underlying cause of the amyloidosis along with symptom management. Our patient is being treated with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) and started on hemodialysis due to progression of renal disease.
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12
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Sulatsky MI, Belousov MV, Kosolapova AO, Mikhailova EV, Romanenko MN, Antonets KS, Kuznetsova IM, Turoverov KK, Nizhnikov AA, Sulatskaya AI. Amyloid Fibrils of Pisum sativum L. Vicilin Inhibit Pathological Aggregation of Mammalian Proteins. Int J Mol Sci 2023; 24:12932. [PMID: 37629113 PMCID: PMC10454621 DOI: 10.3390/ijms241612932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Although incurable pathologies associated with the formation of highly ordered fibrillar protein aggregates called amyloids have been known for about two centuries, functional roles of amyloids have been studied for only two decades. Recently, we identified functional amyloids in plants. These amyloids formed using garden pea Pisum sativum L. storage globulin and vicilin, accumulated during the seed maturation and resisted treatment with gastric enzymes and canning. Thus, vicilin amyloids ingested with food could interact with mammalian proteins. In this work, we analyzed the effects of vicilin amyloids on the fibril formation of proteins that form pathological amyloids. We found that vicilin amyloids inhibit the fibrillogenesis of these proteins. In particular, vicilin amyloids decrease the number and length of lysozyme amyloid fibrils; the length and width of β-2-microglobulin fibrils; the number, length and the degree of clustering of β-amyloid fibrils; and, finally, they change the structure and decrease the length of insulin fibrils. Such drastic influences of vicilin amyloids on the pathological amyloids' formation cause the alteration of their toxicity for mammalian cells, which decreases for all tested amyloids with the exception of insulin. Taken together, our study, for the first time, demonstrates the anti-amyloid effect of vicilin fibrils and suggests the mechanisms underlying this phenomenon.
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Affiliation(s)
- Maksim I. Sulatsky
- Institute of Cytology, Russian Academy of Sciences, 194064 St. Petersburg, Russia; (M.I.S.); (E.V.M.); (I.M.K.); (K.K.T.)
| | - Mikhail V. Belousov
- All-Russia Research Institute for Agricultural Microbiology, 196608 St. Petersburg, Russia; (M.V.B.); (A.O.K.); (M.N.R.); (K.S.A.)
- Faculty of Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anastasiia O. Kosolapova
- All-Russia Research Institute for Agricultural Microbiology, 196608 St. Petersburg, Russia; (M.V.B.); (A.O.K.); (M.N.R.); (K.S.A.)
- Faculty of Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Ekaterina V. Mikhailova
- Institute of Cytology, Russian Academy of Sciences, 194064 St. Petersburg, Russia; (M.I.S.); (E.V.M.); (I.M.K.); (K.K.T.)
| | - Maria N. Romanenko
- All-Russia Research Institute for Agricultural Microbiology, 196608 St. Petersburg, Russia; (M.V.B.); (A.O.K.); (M.N.R.); (K.S.A.)
- Faculty of Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Kirill S. Antonets
- All-Russia Research Institute for Agricultural Microbiology, 196608 St. Petersburg, Russia; (M.V.B.); (A.O.K.); (M.N.R.); (K.S.A.)
- Faculty of Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Irina M. Kuznetsova
- Institute of Cytology, Russian Academy of Sciences, 194064 St. Petersburg, Russia; (M.I.S.); (E.V.M.); (I.M.K.); (K.K.T.)
| | - Konstantin K. Turoverov
- Institute of Cytology, Russian Academy of Sciences, 194064 St. Petersburg, Russia; (M.I.S.); (E.V.M.); (I.M.K.); (K.K.T.)
| | - Anton A. Nizhnikov
- All-Russia Research Institute for Agricultural Microbiology, 196608 St. Petersburg, Russia; (M.V.B.); (A.O.K.); (M.N.R.); (K.S.A.)
- Faculty of Biology, St. Petersburg State University, 199034 St. Petersburg, Russia
| | - Anna I. Sulatskaya
- Institute of Cytology, Russian Academy of Sciences, 194064 St. Petersburg, Russia; (M.I.S.); (E.V.M.); (I.M.K.); (K.K.T.)
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13
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Luhn C, Agis H, Hütterer E, Simonitsch‐Klupp I, Dawoud C, Stift A, Harpain F. Teduglutide in amyloidosis-associated intestinal failure. Clin Case Rep 2023; 11:e7653. [PMID: 37601424 PMCID: PMC10433832 DOI: 10.1002/ccr3.7653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/19/2023] [Indexed: 08/22/2023] Open
Abstract
Amyloidosis is a heterogeneous disease characterized by tissue deposition of abnormally folded fibrillary proteins that can manifest itself by a wide variety of symptoms depending on the affected organs. GI involvement among amyloidosis patients is common. Its clinical manifestation often presents with nonspecific symptoms such as weight loss, diarrhea, and malabsorption. With no specific treatment existing for GI amyloidosis, therapy focuses on impeding amyloid deposition and managing the patients' symptoms with supportive measures. Here, we present an AL-amyloidosis patient with GI involvement and intestinal failure (IF) who was successfully treated with the glucagon-like peptide-2 (GLP-2) analogue teduglutide. Over the course of treatment with teduglutide, the patient was able to achieve independence from parenteral nutrition and experienced a significant improvement in quality of life (QoL) as stool frequency and consistency improved, urinary output was stabilized and body weight as well as body composition improved over the course of teduglutide therapy. With no longer being exposed to the burden and associated risks of parenteral nutrition, we were able to reduce the potential morbidity and mortality rate as well as to improve the patient's overall QoL. Intestinal tissue biopsy workup revealed a histopathological correlate for the clinical response; Congo-Red-positive intestinal depositions almost completely disappeared within 6 months of teduglutide therapy. Implementing intestinotrophic GLP-2 analogue teduglutide may enrich the spectrum of treatment options for amyloidosis patients with IF who are dependent on parenteral support.
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Affiliation(s)
- Clara Luhn
- Division of Visceral Surgery, Department of General SurgeryMedical University ViennaViennaAustria
| | - Hermine Agis
- Division of Hematology and Hemostaseology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Elisabeth Hütterer
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | | | - Christopher Dawoud
- Division of Visceral Surgery, Department of General SurgeryMedical University ViennaViennaAustria
| | - Anton Stift
- Division of Visceral Surgery, Department of General SurgeryMedical University ViennaViennaAustria
| | - Felix Harpain
- Division of Visceral Surgery, Department of General SurgeryMedical University ViennaViennaAustria
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14
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Rosado F, Taveras P, Gayam V, Narendra N, Vigoda I. Intestinal Reactive Amyloid A (AA) Amyloidosis in a Patient With Multiple Myeloma: A Case Report and Literature Review. Cureus 2023; 15:e42906. [PMID: 37664311 PMCID: PMC10474897 DOI: 10.7759/cureus.42906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Amyloidosis is a rare group of disorders characterized by the extracellular deposition of misfolded protein aggregates that interfere with the function of the tissue affected. In some patients, the presenting symptom of monoclonal gammopathies, such as multiple myeloma, can be a gastrointestinal bleed with a further report of amyloidosis in gastrointestinal samples. In all the cases the pathology report is read as AL (light chain) amyloidosis. We present a case of a 57-year-old male patient with no medical history who debuted with gastrointestinal bleeding. A colonoscopy revealed a colonic ulcer with a pathologic diagnosis of amyloid A (AA) amyloidosis. Further investigation led to the finding of multiple myeloma (MM) with no evidence of systemic amyloidosis. Although there is little evidence in the literature of the association or even causative relationship between multiple myeloma and AA amyloidosis, our case highlights the importance of searching for an underlying monoclonal gammopathy like MM in a patient with a confirmed diagnosis of AA amyloidosis.
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Affiliation(s)
- Flor Rosado
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Patxis Taveras
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Vijay Gayam
- Gastroenterology and Hepatology, The Brooklyn Hospital Center, Brooklyn, USA
| | - Nithan Narendra
- Gastroenterology, St. Barnabas Hospital Health System, Bronx, USA
| | - Ivette Vigoda
- Hematology and Oncology, St. Barnabas Hospital Health System, Bronx, USA
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15
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Park HM, Park SY, Choi SJN, Noh MG, Lee TB, Jung YW. Gastrointestinal AA Amyloidosis following Recurrent SARS-CoV-2 Infection: A Case Report. Yonsei Med J 2023; 64:526-529. [PMID: 37488705 PMCID: PMC10375246 DOI: 10.3349/ymj.2022.0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with the overproduction of serum amyloid A protein, resulting in systemic AA amyloidosis. In this report, we describe a case of gastrointestinal (GI) AA amyloidosis following SARS-CoV-2 infection. A 75-year-old male presented to the emergency department with upper abdominal pain 6 weeks post kidney transplantation. He had a history of SARS-CoV-2 infection 4 weeks prior. On day 7 of hospitalization, while receiving conservative management, the patient developed symptoms of cough and fever, leading to a diagnosis of SARS-CoV-2 reinfection. The patient's abdominal pain persisted, and hematochezia developed on day 30 of hospitalization. Esophagogastroduodenoscopy and colonoscopy revealed multiple ulcers in the stomach and colon, with histologic findings revealing the presence of amyloid A. The patient was managed conservatively and was also given remdesivir for the SARS-CoV-2 infection. His clinical symptoms subsequently improved, and endoscopic findings demonstrated improvement in multiple gastric ulcers. GI amyloidosis may be a subacute complication following SARS-CoV-2 infection in immunocompromised patients.
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Affiliation(s)
- Hyung-Min Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seon-Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
| | - Soo Jin Na Choi
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Myung-Giun Noh
- Department of Pathology, Chonnam National University Medical School, Hwasun Hospital, Hwasun, Korea
| | - Tae-Bum Lee
- Department of Pathology, Chonnam National University Medical School, Hwasun Hospital, Hwasun, Korea
| | - Yong-Wook Jung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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16
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Raza D, Prajapati P, Bhavsar V, Raza SM, Papayannis I. Gastrointestinal (GI) Amyloidosis Presenting As Chronic Diarrhea: A Diagnostic Dilemma. Cureus 2023; 15:e41291. [PMID: 37539395 PMCID: PMC10393591 DOI: 10.7759/cureus.41291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/05/2023] Open
Abstract
This case report describes a 63-year-old male patient with a four-year history of chronic diarrhea. Extensive diagnostic investigations failed to reveal a cause. Subsequent upper and lower gastrointestinal (GI) endoscopic procedures revealed the presence of amyloidosis in the GI tract. The patient was referred for further evaluation, but unfortunately, he presented with hypotension and shock, and ultimately succumbed to systemic amyloidosis involving multiple organs. GI amyloidosis, although rare, should be considered in patients presenting with chronic diarrhea, unexplained weight loss, or GI bleeding. Early recognition and appropriate management are crucial for optimizing patient outcomes. Healthcare providers should maintain a high index of suspicion for GI amyloidosis to ensure timely intervention and improve patient care.
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Affiliation(s)
- Daniyal Raza
- Internal Medicine, Louisiana State University Health Shreveport, Shreveport, USA
| | | | - Vatsa Bhavsar
- Internal Medicine, B.J. Medical College, Ahmedabad, IND
| | - Syed Musa Raza
- Gastroenterology, Louisiana State University Health Shreveport, Shreveport, USA
| | - Ioannis Papayannis
- Gastroenterology, Louisiana State University Health Shreveport, Shreveport, USA
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17
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Tahara S, Kohyama M, Nakamitsu A, Sugiyama Y, Tazaki T, Taogoshi H, Komo T, Yamaguchi T, Ueda M, Ishikawa A, Takahashi S, Sasaki M. Surgical strategies for localized colorectal amyloidosis. Surg Case Rep 2023; 9:66. [PMID: 37103609 PMCID: PMC10140200 DOI: 10.1186/s40792-023-01649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Localized colorectal amyloidosis has a good prognosis, but cases involving bleeding or perforation may require surgery. However, there are few case reports discussing the differences in the surgical strategy between the segmental and pan-colon types. CASE PRESENTATION A 69-year-old woman with a history of abdominal pain and melena was diagnosed with amyloidosis localized in the sigmoid colon by colonoscopy. Since preoperative imaging and intraoperative findings could not rule out malignancy, we performed laparoscopic sigmoid colectomy with lymph-node dissection. Histopathological examination and immunohistochemical staining revealed a diagnosis of AL amyloidosis (λ type). We diagnosed localized segmental gastrointestinal amyloidosis, because there was no amyloid protein in the margins, and the tumor was localized. There were no malignant findings. CONCLUSIONS Unlike systemic amyloidosis, localized amyloidosis has a favorable prognosis. Localized colorectal amyloidosis can be classified into the segmental type, in which amyloid protein is deposited locally, and the pan-colon type, in which amyloid protein is deposited extensively in the colon. Amyloid protein causes ischemia due to vascular deposition, weakening of the intestinal wall due to muscle layer deposition, and decreased peristalsis due to nerve plexus deposition. No amyloid protein should remain outside the resection area. The pan-colon type is often reported to cause complications such as anastomotic leakage, and primary anastomosis should be avoided. On the other hand, if there is no contamination or tumor remnants in the margin, the segmental type may be considered for primary anastomosis.
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Affiliation(s)
- Shunya Tahara
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Mohei Kohyama
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan.
| | - Atsushi Nakamitsu
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Yoichi Sugiyama
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Tatsuya Tazaki
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Hiroyuki Taogoshi
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Toshiaki Komo
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Takuro Yamaguchi
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjou, Chuo Ward, Kumamoto, Kumamoto, 860-8556, Japan
| | - Akira Ishikawa
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima, Hiroshima, 734-0037, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima, Hiroshima, 734-0037, Japan
| | - Masaru Sasaki
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan
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18
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Singh S, Gopireddy G, Naum S, Iannetti MP. A Rare Case of Gastrointestinal Amyloidosis Due to Monoclonal Gammopathy of Undetermined Significance. Cureus 2023; 15:e37953. [PMID: 37220448 PMCID: PMC10200344 DOI: 10.7759/cureus.37953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Amyloidosis of the gastrointestinal (GI) tract is caused by the deposition of fibrils made of serum proteins into extracellular spaces. It is an uncommon disease with a poor prognosis, requiring prompt diagnosis and treatment. Treatment for amyloid light chain (AL)-type amyloidosis involves supportive care as well as addressing any underlying plasma cell dyscrasias. We present the case of a 64-year-old female diagnosed with AL-type GI amyloidosis with associated monoclonal gammopathy of undetermined significance. Unfortunately, the treatment was initiated nine months after the initial presentation, and she died one month later. Awareness of GI amyloidosis may allow for faster diagnosis and treatment in future patients.
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Affiliation(s)
- Sarah Singh
- Internal Medicine, Camden Clark Medical Center, Parkersburg, USA
| | - Guru Gopireddy
- Internal Medicine, Camden Clark Medical Center, Parkersburg, USA
| | - Scott Naum
- Gastroenterology, Camden Clark Medical Center, Parkersburg, USA
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19
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Duve RJ, Moga TG, Yang K, Mahl TC, Dove E. Hepatic Amyloidosis With Multiorgan Involvement. ACG Case Rep J 2023; 10:e00999. [PMID: 37091204 PMCID: PMC10115552 DOI: 10.14309/crj.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/03/2023] [Indexed: 04/25/2023] Open
Abstract
Amyloidosis is a diverse entity that poses both diagnostic and treatment challenges. Whether systemic or local, amyloidosis has varied manifestations including occasional hepatic involvement. Hepatic amyloidosis, although rare, should be on the differential for those with unexplained hepatomegaly, cholestasis, alkaline phosphatase elevations, other associated organomegaly, and those with certain epidemiologic risks. In this study, we report a case of a man with systemic amyloid light chain amyloidosis with multiorgan involvement, acute liver injury, cholestasis, nephrotic syndrome, cardiomegaly, and bleeding diathesis.
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Affiliation(s)
- Robert J. Duve
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Tiberiu G. Moga
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Kevin Yang
- Department of Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Thomas C. Mahl
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Eric Dove
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
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20
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Pathophysiology, Functional Assessment and Prognostic Implications of Nutritional Disorders in Systemic Amyloidosis. J Clin Med 2023; 12:jcm12020528. [PMID: 36675458 PMCID: PMC9864940 DOI: 10.3390/jcm12020528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Gastrointestinal involvement is a common clinical feature of patients with systemic amyloidosis. This condition is responsible for invalidating gastrointestinal symptoms, a significant macro and micronutrient deficit, and is a marker of disease severity. Gastrointestinal involvement should be actively sought in patients with systemic amyloidosis, while its diagnosis is challenging in patients with isolated gastrointestinal symptoms. The nutritional status in systemic amyloidosis plays an essential role in the clinical course and is considered a significant prognostic factor. However, the definition of nutritional status is still challenging due to the lack of internationally accepted thresholds for anthropometric and biochemical variables, especially in specific populations such as those with systemic amyloidosis. This review aims to elucidate the fundamental steps for nutritional assessment by using clinical and instrumental tools for better prognostic stratification and patient management regarding quality of life and outcomes.
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21
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Concurrent Cytomegalovirus Colitis and Gastrointestinal Amyloidosis as Initial Presentation of Multiple Myeloma. ACG Case Rep J 2022; 9:e00876. [PMID: 36277736 PMCID: PMC9584183 DOI: 10.14309/crj.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 01/24/2023] Open
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22
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Hani A, Tobón A, Vargas M, Muñoz O. Gastrointestinal bleeding as the first manifestation of gastric amyloidoma: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:503-505. [DOI: 10.1016/j.rgmxen.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022] Open
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23
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Zhao Z, Jiao Y, Yue B, Wang W, Zhao G, Zhang S, Li P. Deep biopsy via endoscopic submucosal dissection for primary gastric amyloidosis. Endoscopy 2022; 54:E236-E237. [PMID: 34102683 DOI: 10.1055/a-1493-2081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Zheng Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yue Jiao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bing Yue
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenjing Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guiping Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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24
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A Rare Case of Pediatric Amyloidosis Presenting as Upper Gastrointestinal Bleeding. J Pediatr Gastroenterol Nutr 2022; 74:e73. [PMID: 34560726 DOI: 10.1097/mpg.0000000000003310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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25
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Anandan M, Ying L, Macisaac B, Kilner A, Laurie R, Naidoo UK. A rare case of gastrointestinal amyloidosis secondary to myeloma with predominant jejunal involvement. J Surg Case Rep 2022; 2022:rjab639. [PMID: 35096368 PMCID: PMC8791659 DOI: 10.1093/jscr/rjab639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/23/2021] [Indexed: 11/14/2022] Open
Abstract
Amyloidosis is a condition identified by the accumulation of abnormal proteins in various tissues and organs that eventually lead to impaired function. Systemic amyloidosis with gastrointestinal (GI) tract involvement is more common than localized GI amyloidosis, whereas predominant jejunal involvement is even more uncommon. We report a rare case of systemic amyloidosis with predominant jejunal involvement in a 76-year-old female who presented with lower abdominal bloating and lethargy.
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Affiliation(s)
- Manoj Anandan
- Correspondence address. Department of General Surgery, Western District Health Service, Hamilton Victoria 3300, Australia. Tel: +61481751086; E-mail:
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26
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Latorre G, Vargas JI, Espino A. Features of gastrointestinal amyloidosis - Authors' reply. Lancet Gastroenterol Hepatol 2021; 6:987. [PMID: 34774160 DOI: 10.1016/s2468-1253(21)00387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Gonzalo Latorre
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile; Endoscopy Unit, Hospital UC-Christus, Santiago, Chile
| | - José Ignacio Vargas
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile; Endoscopy Unit, Hospital UC-Christus, Santiago, Chile
| | - Alberto Espino
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile; Endoscopy Unit, Hospital UC-Christus, Santiago, Chile.
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27
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Simms LN, Suarez LSK, Deeb K, Proenza J. The 13-year bleed: Exuberant amyloid angiopathies, angiodysplasias, and acquired coagulopathies of the gut. SAGE Open Med Case Rep 2021; 9:2050313X211040018. [PMID: 34484792 PMCID: PMC8414616 DOI: 10.1177/2050313x211040018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
Amyloidosis is a disorder characterized by extracellular deposits of proteins that are
prone to aggregate and form insoluble fibrils. Amyloid deposits limited to a single organ
or tissue without the involvement of any other site in the body is uncommon. We report a
75-year-old man with previously treated non-Hodgkin’s lymphoma who presented with
recurrent gastrointestinal hemorrhage. Histopathology showed amyloid deposition within
vascular malformations. His bleeding continued with the cause rooted in the fundamental
building blocks—clotting factors. We discuss the interplay of the pathophysiology of
lymphoma, amyloidosis, and factor X deficiency in a patient with preexisting
angiodysplasias leading to refractory gastrointestinal bleeding. To our knowledge, there
are only 3 reported cases of concomitant amyloidosis and angiodysplasia in the colon, and
none involving the small bowel.
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Affiliation(s)
- Larnelle N Simms
- Internal Medicine Resident, University of Miami Palm Beach Regional GME Consortium, Atlantis, FL, USA
| | - Laura Suzanne K Suarez
- Internal Medicine Resident, University of Miami Palm Beach Regional GME Consortium, Atlantis, FL, USA
| | - Khaled Deeb
- Department of Internal Medicine, West Palm Beach Veterans Affairs Medical Center, West Palm Beach, FL, USA
| | - Jose Proenza
- Department of Gastroenterology, West Palm Beach Veterans Affairs Medical Center, West Palm Beach, FL, USA
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