[Persistent diarrhoea, hypotension, polyneuropathy]

Area of Science:

• Nephrology
• Gastroenterology
• Neurology
• Pathology

Background:

• A 59-year-old male with hypertension and melanoma history presented with severe gastrointestinal and neurological symptoms.
• The patient exhibited diarrhea, weight loss, circulatory collapse, hypotension, polyneuropathy, and worsening renal insufficiency.
• Initial investigations for neoplasms, endocrine, autoimmune, infectious, or neurodegenerative disorders were inconclusive.

Observation:

• A 59-year-old male with hypertension and melanoma history presented with diarrhea, weight loss, and circulatory collapse.
• He also experienced symptomatic hypotension, polyneuropathy, and worsening renal insufficiency.
• Extensive investigations ruled out common causes like neoplasms, endocrine, autoimmune, infectious, or neurodegenerative disorders.

Findings:

• Kidney biopsy revealed AA amyloidosis, despite negative colon biopsies and absence of chronic inflammation or malignancy.
• The patient ultimately succumbed to multiple organ failure.

Implications:

• The triad of diarrhea, polyneuropathy, and hypotension should prompt suspicion for amyloidosis.
• This case underscores the importance of considering rare diagnoses in complex clinical presentations.
• Timely recognition of AA amyloidosis can potentially guide earlier therapeutic interventions.