Hematemesis without Primary sclerosing cholangititis in a case of Ulcerative Colitis

Abstract

Background: Hematemesis without Primary sclerosing cholangititis in a case of Ulcerative Colitis. Aims: We present a case of ulcerative colitis on treatment who presented with hematemesis due to an unusual complication of IBD involving liver and causing portal hypertention. Methods: A 60 years lady with Ulcerative colitis since 14 years controlled on mesalamine presented with hematemesis and ascites.On evaluation large varices were seen and hemostasis achieved with endoscopic variceal ligation. Ascites was high SAAG without spontaneous bacterial peritonitis. On evaluation for the cause of liver disease autoimmune profile,viral markers and ceruloplamin were normal. Triple phase CT evaluation revealed multiple retroperitoneal,iliac and inguinal lymph nodes. Biopsy of lymph nodes showed amyloidosis. Ascites was conservatively managed. Results: This is the first case to our knowledge where initial presentation of amyloidosis secondary to inflammatory bowel disease,which itself is very rare, presented with a portal hypertention complication. Conclusion: This case of hematemesis as the index presentation of portal hypertention due to amyloidosis secondary to IBD emphasizes the importance of routine liver evaluation in all cases of inflammatory bowel disease.