A Case of Secondary Gastrointestinal Amyloidosis with Bleeding of Duodenal Ulcer

Taro Oshikiri¹⁾²⁾, Fumitaka Nakamura¹⁾, Mitsuru Dohke¹⁾, Kyousuke Miyazaki¹⁾²⁾, Hiroyuki Kaneko¹⁾²⁾, Yoshiaki Narita¹⁾, Nobuichi Kashimura¹⁾, Osamu Matsunami¹⁾, Satoshi Kondo²⁾ and Hiroyuki Katoh²⁾

Department of Surgery, Teine Keijinkai Hospital¹⁾, Second Department of Surgery, Hokkaido University Hospital²⁾

In a case of AA gastrointestinal amyloidosis with duodenal ulcer bleeding secondary to rheumatoid arthritis (RA), a 60-year-old woman who had suffered from RA for over 25 years was admitted to our institute due to bleeding from a duodenal ulcer. Several attempts at endoscopic hemostasis failed, necessitating an emergency distal gastrectomy. Histologically, the gastric specimen showed amyloid deposition confirmed by Congo-red staining and immunostaining for amyloid A protein. The patient died postoperatively due to multiple organ failure (MOF). Autopsy revealed a total amyloid lesion. RA accounts for 60% of all disease involving secondary amyloidosis. NSAIDs, often used to treat RA, are well known to cause gastroduodenal ulcers. Our case thus suggests that secondary amyloidosis be considered as a cause when gastroduodenal ulcer bleeding is seen in patients of RA.

Key words
secondary gastrointestinal amyloidosis, acute bleeding of duodenal ulcer, rheumatoid arthritis

Reprint requests
Taro Oshikiri Second Department of Surgery, Hokkaido University Hospital N-14, W-5, Sapporo, 060-8648 JAPAN

Accepted
July 25, 2000

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