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Multiple Myeloma Associated Intestinal Amyloidosis: Intestinal Pseudoobstruction Falsely Considered as an Ascites

[ Vol. 13 , Issue. 1 ]

Author(s):

Vladimir Milivojevic*, Maja Stojanovic, Ivan Rankovic, Marjan Micev, Rada Jesic Vukicevic and Tomica Milosavljevic   Pages 79 - 81 ( 3 )

Abstract:


Introduction: Amyloidosis is a group of diseases pathohistologically diagnosed by characteristic extracellular deposition of an abnormal fibrillary protein (i.e. amyloid) into organs, leading to organ dysfunction secondary to destruction of normal tissue architecture. Methods: Case-report of a 44 year-old female, presenting with massive abdominal distension clinically suspected of ascites.

Results: On admission, the patient was complaining of nausea, vomiting, abdominal pain, distension and bloating associated with weight loss and diarrhoea. Her prior medical history revealed a treatment naïve viral hepatitis C (HCV) infection with normal liver tests. She was on long term haemodialysis due to end-stage renal disease. Based on clinical, laboratory and radiology findings we established the diagnosis of light chain amyloidosis associated with multiple myeloma, complicated with amyloid bowel depositions and intestinal pseudo-obstruction. On imaging, diffuse liver enlargement was seen. Liver biopsy could have rendered the possible cause of hepatomegaly, but patient’s noncompliance hindered the answer whether liver involvement was the consequence of a chronic hepatitis due to HCV infection or amyloid accumulation. Unfortunately, consequent patient’s death prevented specific treatment implementation.

Conclusion: Patients with multiple myeloma and obscure abdominal complaints should be worked up for amyloidosis. Intestinal pseudo-obstruction due to amyloidosis can imitate in certain instances ascites hence complicating diagnostic algorithm. In such complex clinical cases, close collaboration between surgeon, gastroenterohepatologist and haematologist is necessary.

Keywords:

Amyloidosis, ascites, case-report, haemodialysis, intestinal pseudo-obstruction, multiple myeloma.

Affiliation:

Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Clinic for Allergology and Immunology, Clinical Center of Serbia, Belgrade, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Department of Pathohistology, Clinical Center of Serbia, Belgrade, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade

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