Non-Infectious Cause of an Acute Lower Gastrointestinal Bleeding in an HIV-Infected Male Patient

Abstract

Purpose: Amyloidosis is an unusual disease which clinicians may not consider when confronted with a patient complaining of lower gastrointestinal (GI) bleeding. Methods: Primary amyloidosis is more common than secondary amyloidosis but GI involvement is less common in primary amyloidosis. Patients with Primary GI amyloidosis have polypoid protrusions and thickening of the valvulae conniventes on colonoscopy whereas patients with secondary GI amyloidosis have mucosal friability and erosions. Results: A 57-year-old African American male with PMH of AIDS presented with the chief complaint of hematochezia for the past three days. Review of systems was significant for intermittent headaches, dyspnea on exertion and generalized weakness. Patient's current medications include lamivudine, zidovudine, indinavir, ritonavir and low dose aspirin. Patient had 15 pack year smoking history and intravenous drug abuse with heroin and cocaine. Patient's physical examination was significant for mild conjuctival pallor. Labs reveal normocytic anemia. Colonoscopy showed multiple erosions and ulcers in the terminal ileum as well as continuous inflammation of colonic mucosa (Figure 1) from the rectum to approximately 30 cm from anal verge with abrupt transition to normal mucosa and multiple biopsies were taken from these areas. Histology revealed marked amyloid deposits (Figure 2) in the vessel walls. Patient was referred for hematology evaluation but unfortunately he failed to follow-up.Figure: No Caption available.Figure: [1187]Conclusion: This case serves to heighten awareness to the possible diagnosis of GI amyloidosis in patients presenting with lower GI bleeding.