Systemic amyloidosis causing intestinal hemorrhage and pseudo-obstruction

Area of Science:

• Gastroenterology
• Hematology
• Pathology

Background:

• Amyloidosis is characterized by the deposition of misfolded proteins in tissues.
• Primary amyloidosis (AL) arises from immunoglobulin light chains, often associated with plasma cell disorders like multiple myeloma.
• Gastrointestinal involvement in amyloidosis presents with diverse, non-specific symptoms.

Observation:

• A 70-year-old male presented with persistent small bowel obstruction.
• Surgical exploration revealed pseudo-obstruction and hemorrhagic enteritis.
• Bone marrow biopsy confirmed multiple myeloma; subsequent upper GI biopsies showed amyloid deposition.

Findings:

• The patient's presentation was consistent with AL amyloidosis secondary to multiple myeloma.
• Amyloid deposition was confirmed in the stomach and duodenum.
• Gastrointestinal manifestations are common in systemic amyloidosis.

Implications:

• Vague abdominal complaints in multiple myeloma patients warrant a high index of suspicion for amyloidosis.
• Early recognition of gastrointestinal amyloidosis can guide treatment and improve patient outcomes.
• This case highlights the importance of integrating hematologic and gastrointestinal findings for accurate diagnosis.