Guru Pramod Kumar, Iyer Vivek N
Department of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA.
Am J Case Rep. 2016 Mar 16;17:170-2. doi: 10.12659/ajcr.896511.
Amyloidosis is a multisystem disease, and can present with multitude of nonspecific symptoms. Gastrointestinal amyloidosis is common, and gastrointestinal (GI) bleeding in these patients has a wide differential diagnosis. The present case features the distinctive endoscopic finding of submucosal hematoma as a clue to immunoglobin light chain (AL) amyloid involvement of the gastrointestinal tract.
An 81-year-old woman with AL amyloidosis was transferred to the intensive care unit (ICU) for evaluation of GI bleeding. Prior to the bleeding episode, the patient had undergone paracentesis for management of her ascites related to restrictive cardiomyopathy. Initial evaluation was negative for any intra-abdominal catastrophe related to her recent paracentesis. Upper gastrointestinal endoscopy was negative for any source of bleeding. However, colonoscopy showed a ruptured submucosal hematoma, which is a rare but classical finding in patients with amyloidosis. The patient was managed conservatively and did not have any further episodes of bleeding in the hospital. She unfortunately died due to her primary illness 6 weeks after discharge from the hospital.
The finding of submucosal hematoma on endoscopy is a rare but sentinel sign for amyloidosis involvement in the GI tract.
淀粉样变性是一种多系统疾病，可表现出多种非特异性症状。胃肠道淀粉样变性很常见，这些患者的胃肠道（GI）出血有广泛的鉴别诊断。本病例的特征是内镜下发现独特的黏膜下血肿，这是免疫球蛋白轻链（AL）淀粉样变性累及胃肠道的线索。
一名81岁的AL淀粉样变性女性因胃肠道出血被转入重症监护病房（ICU）进行评估。在出血发作之前，患者因限制性心肌病相关腹水接受了腹腔穿刺术。初步评估未发现与她最近的腹腔穿刺术相关的任何腹腔内灾难。上消化道内镜检查未发现任何出血源。然而，结肠镜检查显示有一个破裂的黏膜下血肿，这在淀粉样变性患者中是一种罕见但典型的发现。患者接受了保守治疗，住院期间没有再次出血。不幸的是，她在出院6周后因原发性疾病去世。
内镜检查发现黏膜下血肿是淀粉样变性累及胃肠道的一种罕见但具有警示意义的征象。
