A case of endoscopic ultrasound diagnosis of gastric amyloidosis

Abstract

Amyloidosis is among a group of diseases caused by a variety of amyloid deposition in the interstitial space that causes damage to cells and organ function, affecting the heart, kidneys, gastrointestinal tract, skin, nervous system, and others. The digestive system is one of the most common encroachment sites of amyloidosis, and it was reported that the gastrointestinal tract was affected in approximately 50-70% of cases (1,2). However, amyloidosis that is limited only to the stomach is rare, and might be prone to misdiagnosis because of its various clinical manifestations and non-specific laboratory tests and imaging examinations. We describe a case of gastric amyloidosis diagnosed by endoscopic ultrasonography (EUS). CASE REPORTA 37-year-old female presented to our hospital with the complaint of abdominal distension for one month. In our hospital, she underwent a gastroscopy examination with biopsies, which showed extensive chyme retention and varying erosion and ulceration of the gastric body ( Figure 1). The pathology showed moderate chronic inflammation and erosion of the gastric body mucosa, with accompanying Helicobacter pylori (Hp) infection.

Evaluation of the Inflammatory Response After Eradication of Helicobacter pylori in Patients With Familial Mediterranean Fever

“…A study concluded that Hp positivity could cause symptoms that could explain the inefficacy of colchicine in patients with a diagnosis of FMF and high CRP values 23 . In the literature, it was reported that there is basal inflammation in the non-attack period in patients with a diagnosis of FMF 4,6,19,20 . Observing higher CRP and hs-CRP values in patients with FMF in our study supports this state.…”

“…23 In the literature, it was reported that there is basal inflammation in the nonattack period in patients with a diagnosis of FMF. 4,6,19,20 Observing higher CRP and hs-CRP values in patients with FMF in our study supports this state.…”

“…Recently, numerous studies on FMF have shown inflammatory indicators to be high not only during the attack period but also during the non-attack period in some patients. This condition was interpreted as the presence of subclinical inflammation in FMF 6 …”

“…This condition was interpreted as the presence of subclinical inflammation in FMF. 6 Since the pyrin protein is genetically mutated, it is believed that the inflammatory response cannot be controlled in patients with FMF. 2,7,8 Pyrin protein blocks the activation of the Caspase-1 (CASP-1) enzyme; which is responsible for the proteolytic activation of Interleukin-1ß (IL-1ß) cytokine of ASC and the stimulation of the apoptosis pathway by binding to the pyrin region of ASC.…”