Multiple colonic pseudopolyposis due to amyloidosis; presenting with lower gastrointestinal bleed

Abstract

Gastrointestinal involvement (mucosal or neuromuscular) is common in patients with primary and secondary amyloidosis. Mucosal lesions, ulcers or pseudopolypi (submucosal polyps) are commonly seen in stomach or proximal small bowel and are occasional source of overt or occult gastrointestinal bleed. We present a patient with diffuse polypoid lesions in colon presenting with lower gastrointestinal bleed. A 51 year-old healthy black male presented with one year history of intermittent hematochezia without any local or systemic symptoms. Physical exam was remarkable for palor without any peripheral lymphadenopathy or hepatosplenomegaly. Laboratory evaluation revealed Hct 23.0 ml/dl, MCV 65/ m3 Ferritin 12ng/ml, BUN 12mg/dl. Creatinine 1.0mg/dl. Serum electrophoresis was normal. Colonoscopy showed multiple polypoid lesions varying from 0.5 cm to 1.5 cms distributed throughout colon. Biopsy showed extensive submucosal amorphous eosinophilic material and positive staining with Congo red consistent with amyloidosis. Enteroscopic examination revealed extensive polypoid lesions in stomach and proximal small bowel. Cardiac echocardiogram was normal. Patient continued to have intermittent hematochezia requiring frequent blood transfusions and iron replacement. Gastrointestinal amyloidosis is a rare cause of gastrointestinal bleeding and colonic pseudopolypi due to submucosal amyloid deposit may manifest with lower gastrointestinal tract bleeding.