Basavaraju Krishna Prakash, Mansour Dina, Barnes Stuart, Whitehead Mark W, Bruce Stuart A
St Thomas' Hospital, Gastroenterology, College house, Lambeth Palace Road, London, SE1 7EH, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0358. Epub 2009 Apr 15.
An 82-year-old woman was admitted with severe vomiting and progressive dysphagia mainly to solids. She gave a 3-month history of increasing heartburn, vomiting, tiredness, lethargy, anorexia and 13 kg weight loss. Her past medical history was unremarkable and she was a non-smoker. Physical examination revealed evidence of significant weight loss and dehydration only. Gastroscopy revealed mild oesophagitis, tongues of Barrett oesophagus and mild antral gastritis. CT scan of the thorax and abdomen was normal. Unfortunately her condition deteriorated rapidly and she died from aspiration pneumonia. Postmortem examination revealed thickening of the muscular wall of lower oesophagus and pylorus, but without any malignancy. The histological assessment of the oesophageal as well as gastric biopsies confirmed the diagnosis of gastrointestinal amyloidosis accounting for her symptoms of dysphagia and vomiting respectively.
一名82岁女性因严重呕吐和进行性吞咽困难（主要是固体食物）入院。她有3个月的烧心、呕吐、疲倦、乏力、厌食病史，体重减轻13公斤。她既往病史无特殊，不吸烟。体格检查仅发现明显体重减轻和脱水迹象。胃镜检查显示轻度食管炎、巴雷特食管舌样改变和轻度胃窦炎。胸部和腹部CT扫描正常。不幸的是，她的病情迅速恶化，死于吸入性肺炎。尸检显示食管下段和幽门肌壁增厚，但无任何恶性病变。食管及胃活检的组织学评估分别证实了胃肠道淀粉样变性的诊断，这可以解释她的吞咽困难和呕吐症状。
