Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report
Abstract Background Amyloidosis is characterized by extracellular tissue deposition of fibrils, composed of insoluble low-molecular-weight protein subunits. The type, location, and extent of fibril deposition generates variable clinical manifestations. Gastrointestinal (GI) bleeding due to amyloid d...
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-021-01882-7 |
| _version_ | 1818356594035916800 |
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| author | Rachael Chan Stephanie Carpentier |
| author_facet | Rachael Chan Stephanie Carpentier |
| author_sort | Rachael Chan |
| collection | DOAJ |
| description | Abstract Background Amyloidosis is characterized by extracellular tissue deposition of fibrils, composed of insoluble low-molecular-weight protein subunits. The type, location, and extent of fibril deposition generates variable clinical manifestations. Gastrointestinal (GI) bleeding due to amyloid deposition is infrequent. Previous literature describes upper GI bleeding (UGIB) in patients with known amyloid disease. Here, we describe a case of recurrent UGIB that ultimately led to a diagnosis of GI amyloidosis and multiple myeloma in a patient with no history of either. Case presentation A 76-year-old male presented to the emergency department with frank hematemesis, melena, and a decreased level of consciousness. Management required intensive care unit (ICU) admission with transfusion, intubation, and hemodynamic support. Upper endoscopy revealed gastritis with erosions and nodularity in the gastric cardia and antrum. Hemostasis of a suspected bleeding fundic varix could not be achieved. Subsequently, the patient underwent computerized tomography (CT) angiography and an interventional radiologist completed embolization of the left gastric artery to address potentially life-threatening bleeding. Complications included development of bilateral pleural effusions and subsegmental pulmonary emboli. Pleural fluid was negative for malignancy. He was transferred to a peripheral hospital for continued care and rehabilitation. Unfortunately, he began re-bleeding and was transferred back to our tertiary center, requiring re-admission to the ICU and repeat endoscopy. Repeat biopsy of the gastric cardial nodularity was reported as active chronic gastritis and ulceration. However, based on the unusual endoscopic appearance, clinical suspicion for malignancy remained high. He exhibited symptoms of congestive heart failure following standard resuscitation. Transthoracic echocardiogram (TTE) demonstrated a reduced ejection fraction of 35–40% and a strain pattern with apical sparing. Following discussions between the treating gastroenterologist, consulting cardiologist, and pathologist, Congo Red staining was performed, revealing submucosal amyloid deposits. Hematology was consulted and investigations led to diagnosis of multiple myeloma (MM) and immunoglobulin light-chain (AL) amyloidosis. The patient was treated for MM for four months prior to cessation of therapy due to functional and cognitive decline. Conclusions GI amyloidosis can present with various non-specific clinical symptoms and endoscopic findings, rendering diagnosis a challenge. This case illustrates GI amyloidosis as a potential—albeit rare—etiology of UGIB. |
| first_indexed | 2024-12-13T19:59:41Z |
| format | Article |
| id | doaj.art-8aa0bf117ae64bd6bebbecfd3da37d03 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-13T19:59:41Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-8aa0bf117ae64bd6bebbecfd3da37d032022-12-21T23:33:14ZengBMCBMC Gastroenterology1471-230X2021-07-012111410.1186/s12876-021-01882-7Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case reportRachael Chan0Stephanie Carpentier1Department of Medicine, Dalhousie University and Nova Scotia Health, QEII Health Sciences CentreDepartment of Medicine, Dalhousie University and Nova Scotia Health, QEII Health Sciences CentreAbstract Background Amyloidosis is characterized by extracellular tissue deposition of fibrils, composed of insoluble low-molecular-weight protein subunits. The type, location, and extent of fibril deposition generates variable clinical manifestations. Gastrointestinal (GI) bleeding due to amyloid deposition is infrequent. Previous literature describes upper GI bleeding (UGIB) in patients with known amyloid disease. Here, we describe a case of recurrent UGIB that ultimately led to a diagnosis of GI amyloidosis and multiple myeloma in a patient with no history of either. Case presentation A 76-year-old male presented to the emergency department with frank hematemesis, melena, and a decreased level of consciousness. Management required intensive care unit (ICU) admission with transfusion, intubation, and hemodynamic support. Upper endoscopy revealed gastritis with erosions and nodularity in the gastric cardia and antrum. Hemostasis of a suspected bleeding fundic varix could not be achieved. Subsequently, the patient underwent computerized tomography (CT) angiography and an interventional radiologist completed embolization of the left gastric artery to address potentially life-threatening bleeding. Complications included development of bilateral pleural effusions and subsegmental pulmonary emboli. Pleural fluid was negative for malignancy. He was transferred to a peripheral hospital for continued care and rehabilitation. Unfortunately, he began re-bleeding and was transferred back to our tertiary center, requiring re-admission to the ICU and repeat endoscopy. Repeat biopsy of the gastric cardial nodularity was reported as active chronic gastritis and ulceration. However, based on the unusual endoscopic appearance, clinical suspicion for malignancy remained high. He exhibited symptoms of congestive heart failure following standard resuscitation. Transthoracic echocardiogram (TTE) demonstrated a reduced ejection fraction of 35–40% and a strain pattern with apical sparing. Following discussions between the treating gastroenterologist, consulting cardiologist, and pathologist, Congo Red staining was performed, revealing submucosal amyloid deposits. Hematology was consulted and investigations led to diagnosis of multiple myeloma (MM) and immunoglobulin light-chain (AL) amyloidosis. The patient was treated for MM for four months prior to cessation of therapy due to functional and cognitive decline. Conclusions GI amyloidosis can present with various non-specific clinical symptoms and endoscopic findings, rendering diagnosis a challenge. This case illustrates GI amyloidosis as a potential—albeit rare—etiology of UGIB.https://doi.org/10.1186/s12876-021-01882-7Upper GI bleedingAmyloidosisCase report |
| spellingShingle | Rachael Chan Stephanie Carpentier Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report BMC Gastroenterology Upper GI bleeding Amyloidosis Case report |
| title | Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report |
| title_full | Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report |
| title_fullStr | Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report |
| title_full_unstemmed | Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report |
| title_short | Gastric amyloidosis presenting as acute upper gastrointestinal bleeding: a case report |
| title_sort | gastric amyloidosis presenting as acute upper gastrointestinal bleeding a case report |
| topic | Upper GI bleeding Amyloidosis Case report |
| url | https://doi.org/10.1186/s12876-021-01882-7 |
| work_keys_str_mv | AT rachaelchan gastricamyloidosispresentingasacuteuppergastrointestinalbleedingacasereport AT stephaniecarpentier gastricamyloidosispresentingasacuteuppergastrointestinalbleedingacasereport |