A Case of Secondary Amyloidosis Presented with Perforation of the Small Intestine.

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  • 消化管穿孔で発症した続発性アミロイドーシスの１例

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Abstract

We report a case of secondary amyloidosis presented with perforation of the small intestine.<br> A 61-year-old woman with a 30-year history of rheumatoid arthritis (RA) was admitted to the hospital for angina pectoris. Because of sudden onset of bloody stool and lower abdominal pain, the patient was diagnosed as having peritonitis due to intestinal perforation. An emergency operation was made. A pinhole like perforation was observed in the congested and edematous terminal ileum. Ileocecal resection was performed. Multiple irregular mucosal ulcers were observed in the resected specimen. Deposition of amyloid was noted with a polarized light microscopy after Congo red staining, which was sensitive for KMnO4 treatment. Histological diagnosis was AA type amyloidosis. After the operation, severe complications ensued, but she recovered with conservative treatment.<br> Intestinal perforation resulting from amyloidosis is very rare, so far 25 cases have been reported in the Japanese literature, and the most common underlying disease of them is RA. In the treatment of the patient with acute abdomen with a history of RA, secondary amyloidosis must be kept in mind.

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