Weight Loss and Gastrointestinal Bleeding from Gastric Amyloidosis Secondary to Occult Plasma Cell Myeloma

1Cleveland Clinic Foundation, Cleveland, OH

Meeting: Hospital Medicine 2007, May 23-25, Dallas, Texas

Abstract number: 124

Case Presentation:

A62‐year‐old white man with a medical history of hypothyroidism and atrial fibrillation was admitted for evaluation of early satiety, nausea, lethargy, and a 20‐pound weight loss over the preceding 3 weeks. On physical examination, he appeared to be well built and nourished with no significant findings. A complete blood count and renal function were normal. His liver enzymes were elevated, with an ALT of 83 U/L, an AST of 140 U/L and an alkaline phosphatase of 758 U/L. Stool hemoccult was positive for blood. Computed tomography scans of the abdomen and pelvis revealed no abnormality. Esophagogastroduodenoscopy (EGD) showed a small amount of blood over the lesser curvature of the stomach. Endoscopic ultrasound revealed irregularity of the mucosa over the lesser curvature, and multiple biopsies were taken. The biopsies were negative for Helicobacterpylori but revealed benign gastric mucosa with extensive amyloid deposition. Urine protein electro‐phoresis was consistent with monoclonal gammopathy, IgA kappa type, and free kappa monoclonal light chains. However, examination of the bone marrow revealed an increased proportion of plasma cells. Immunological stains for CD 138, kappa, and lambda showed approximately 30% plasma cells with kappa light chain restriction. These findings were consistent with plasma cell dyscrasia favoring plasma cell myeloma with amyloid deposition. The hematology service was consulted, and dexamethasone was started for symptom control. He was discharged home with recommendations for outpatient follow‐up in hematology.

Discussion:

The gastrointestinal tract is one of the commonly involved regions in systemic amyloidosis. Symptoms of epigastric discomfort, poor appetite, hematemesis, and hematochezia predominate. Gastric perforation can sometimes occur in the disease process because of local auto‐nomic nervous system involvement and gastric wall structure damage. Systemic amyloidosis usually has an unfavorable prognosis. Although several treatment strategies have been directed at both supporting the affected organs and dealing with the underlying specific disease, their effectiveness is yet to be determined.

Conclusions:

Amyloidosis involving the gastrointestinal tract can produce a wide variety of nonspecific symptoms that can mimic peptic ulcer disease, inflammatory bowel disease, and colon carcinoma. A high index of suspicion is necessary to reach an early diagnosis. No specific treatment exists for this condition. Local resection may be effective in localized disease. Melphalan‐ and colchicine‐based chemotherapeutic regimens have been used for systemic amyloidosis with variable success.

Author Disclosure:

R. B. Hebbar, None; V. Dimov, None; A. Aneja, None; A. Kumar, None.

To cite this abstract:

Hebbar R, Dimov V, Aneja A, Kumar A. Weight Loss and Gastrointestinal Bleeding from Gastric Amyloidosis Secondary to Occult Plasma Cell Myeloma. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 124. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/weight-loss-and-gastrointestinal-bleeding-from-gastric-amyloidosis-secondary-to-occult-plasma-cell-myeloma/. Accessed November 12, 2019.

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