2672 Gastric Amyloidosis: A Rare Cause of Gastropathy and GI Bleeding

Abstract

INTRODUCTION: Amyloidosis is a disorder of protein deposition that often presents with systemic symptoms. Symptoms of GI amyloidosis include abdominal pain, upper and lower GI bleeding, weight loss, diarrhea, malabsorption, esophageal reflux, and spontaneous bowel perforation. GI amyloidosis involves, from most to least common, the duodenum, stomach, colorectum, and the esophagus. In this case report, we will present a rare case of symptomatic AL amyloidosis localized to the stomach in which diagnosis and management was delayed by 3 months. CASE DESCRIPTION/METHODS: The patient was a 64-year-old African American woman who presented with a one-day history of fatigue and shortness of breath and a one-week history of dark stools. She had a past medical history significant for untreated plasma cell myeloma and chronic anemia. The patient had an EGD for intermittent dark stools 3 months prior to this admission which demonstrated severe gastropathy on endoscopic exam, but unfortunately no biopsies were taken at that point. The etiology of gastropathy remained unclear and nonspecific. During this hospitalization, with the patient’s ongoing history of melena, she underwent a repeat EGD which again showed severe localized gastropathy in the proximal stomach. A gastric biopsy was obtained from the area. On pathology review, the biopsy showed deposition of amorphous, eosinophilic material, suspicious for amyloid. Congo Red stain highlighted apple green birefringent material, consistent with amyloid. Patient remained hemodynamically stable during the hospital admission and was discharged before the pathology results were back. A week later, she was called to notify her of the results and to follow up with hematology oncology, but unfortunately patient had passed away at home, and the reason of death remained unclear. DISCUSSION: In a patient with GI bleed or other GI symptoms such as abdominal pain, nausea/vomiting, or change in bowel habits a probable etiology of amyloidosis should be on the differential, especially with history of plasma cell dyscrasia. Evaluation should include endoscopy with biopsy and specific amyloid staining if any obvious lesion is noted. Localized gastric amyloidosis presenting with GI bleeding is rare. This rarity may lead clinicians to dismiss it as a possibility which can delay diagnosis and proper management. This case report demonstrates such a situation in which a patient with plasma cell myeloma and symptoms of GI bleeding was delayed diagnosis and management by 3 months.