Duodenal amyloidosis secondary to ulcerative colitis

Abstract

Amyloidosis is defined as the extracellular deposition of non-branching fibrils composed of a variety of serum-protein precursors. Secondary amyloidosis is associated with several chronic inflammatory conditions, such as rheumatologic or intestinal diseases, familial Mediterranean fever, or chronic infectious diseases, such as tuberculosis. Although the association of amyloidosis with inflammatory bowel disease is known, amyloidosis secondary to ulcerative colitis (UC) is rare. A 36-year-old male patient with a 15-year history of UC presented with nausea, vomiting, and abdominal pain. He had been treated with infliximab for 6 years. At the time of admission, he had been undergoing treatment with mesalazine and adalimumab since the preceding 5 months. Esophagogastroduodenoscopy showed mucosal erythema, edema, and erosions with geographic ulcers at the 2nd and 3rd portions of the duodenum. Duodenal amyloidosis was diagnosed using polarized light microscopy and Congo red stain. Monoclonal gammopathy was not detected in serum and urine tests, while the serum free light chain assay result was not specific. An increase in plasma cells in the bone marrow was not found. Secondary amyloidosis due to UC was suspected. The symptoms were resolved after glucocorticoid therapy.

Rheumatoid arthritis: Extra-articular manifestations and comorbidities

“…Amyloid deposits in the gastrointestinal tract can cause acute obstruction or significant bleeding. Depending on the location in the intestine, amyloid can also cause abdominal pain, nausea, malabsorption and chronic diarrhoea [72].…”

Therapeutic effects of biological treatments on AA amyloidosis associated with inflammatory bowel disease: a case report and literature review

“…Adalimumab (ADA) is a completely human anti-TNFα antibody and is licensed for the treatment of IBD [54][55][56][57][58]. Adalimumab was used in one case as a first-line biologic treatment and resulted in an improvement in proteinuria and renal function [34], but after infliximab's loss of response, adalimumab was found to be ineffective [3,36,38]. In clinical practice, azathioprine or methotrexate combination therapy increases efficacy and decreases immunogenicity, although combination therapy must be balanced against a potential rise in adverse events over time.…”

“…There are several tools for amyloid typing, including immunofluorescence, immunohistochemistry, immunoelectron microscopy, and proteomic studies [14,46]. Unfortunately, amyloid typing was not used in 11 reported cases [3,23–29,32,35,36,38]. We found that AA amyloidosis may be accompanied by other related disorders beside IBD, such as arthropathy or arthritis, which was the most reported disorder [3,22,26,29,34], FMF [3], or other extraintestinal manifestations [3,34].…”

“…Infliximab was the first drug for IBD, so it is natural that it is the most widely used drug [50]. In the majority of cases, infliximab was able to improve proteinuria or renal function [3,22,24,25,27–29,31,34,36,37]; additionally, infliximab contributed to patient stability and prevented the progression of proteinuria or renal injury [3,23,30,34,35]; Unfortunately, infliximab failed in a number of cases, which either led to the progression of proteinuria or renal function [3,26,32,34,36,38]. Although infliximab therapeutic drug monitoring is more effective in maintaining disease control [51].…”

Intestinal amyloidosis: Clinical manifestations and diagnostic challenge

“…For severe malabsorption, total parenteral nutrition may be useful if dysmotility-related symptoms are disabling, and the patient becomes malnourished. 31…”