Apple Green Gastritis: A Case of Gastric Amyloidosis

Abstract

Case: A 55-year-old African American male with a past medical history of DM II presented to clinic for evaluation of GERD. Patient reports that symptoms started several years ago. He noted intermittent episodes of nausea, vomiting, mid-sternal chest discomfort, and increased bloating. He also reports having coffee ground emesis and black stool two and a half months ago.Initial results from the CMP, CBC, amylase and lipase were normal.CT abdominal/pelvis were unremarkable. An EGD performed for this evaluation was positive for chronic active gastritis. Biopsy results were positive for amyloidosis. The patient was was diagnosed with AL-type gastric amyloidosis and plasma cell dyscrasia. Discussion: Amyloidosis is a rare disorder characterized by the extracellular deposition of an abnormal fibrillar protein. Amyloidosis can be acquired or hereditary and systemic or localized to a single organ, such as the gastrointestinal tract.Amyloidosis is divided into six types with primary (AL) amyloidosis being the most common form. AL amyloidosis is associated with plasma cell dyscrasis and has the maximum gastrointestinal involvement. Gastric involvement occurs in 8% of patients by biopsy and 12% by autopsy, with only 1% being symptomatic. GI symptoms are usually nonspecific and they often include dysphagia, abdominal pain, hemorrhage, constipation, diarrhea and malabsorption. Histopathological patterns of amyloid deposition are associated with clinical and endoscopic features. The most common endoscopic findings include a fine granular appearance, polyps, erosions, ulcerations, and mucosal friability. There is no specific treatment for gastric amyloidosis but recently high-dose chemotherapy with hematopoietic stem cell transplantation has been used for AL amyloidosis with a 5-year survival rate of 60%.Figure: No Caption available.Figure: No Caption available.