Cirugía General y del Aparato Digestivo, Hospital Universitario Clínico San Cecilio, España.
Rev Esp Enferm Dig. 2023 Feb;115(2):93-94. doi: 10.17235/reed.2022.8971/2022.
Amyloidosis with gastrointestinal involvement is a rare cause of chronic diarrhoea, and should be considered especially in adult patients with intestinal malabsorption and extra GI manifestations. We present the case of a male patient who, after an oncological gastrectomy, presented with chronic diarrhea that did not respond to treatment and, after study, the cause of the diarrhea was finally found. Primary systemic light chain amyloidosis (AL) initially presents as chronic diarrhea and weight loss after gastrectomy. Immunohistochemistry was completely negative for amyloid A, which virtually rules out AA amyloidosis. With regard to the immunoglobulin chains, an amyloid signal was observed for both light chains, with a predominance of lambda light chain but not entirely conclusive. This situation is not uncommon since amyloid, whatever its chemical nature, can annex serum proteins, including immunoglobulin chains. In the case of chronic diarrhea, the possibility of amyloidosis should be kept in mind, especially in the case of weight loss.
胃肠道受累的淀粉样变性是慢性腹泻的罕见病因，尤其应考虑在有肠吸收不良和胃肠道外表现的成年患者中。我们报告了 1 例男性患者，他在接受了肿瘤学胃切除术后出现慢性腹泻，经治疗后未见缓解，在研究后最终确定了腹泻的病因。原发性系统性轻链淀粉样变性（AL）最初表现为胃切除术后的慢性腹泻和体重减轻。淀粉样 A 的免疫组化完全阴性，几乎排除了 AA 淀粉样变性。关于免疫球蛋白链，两种轻链均观察到淀粉样信号，以 lambda 轻链为主，但并不完全确定。这种情况并不少见，因为无论其化学性质如何，淀粉样物质都可以附着在血清蛋白上，包括免疫球蛋白链。在慢性腹泻的情况下，应考虑淀粉样变性的可能性，尤其是在体重减轻的情况下。
