title: [An autopsy case of protein-losing enteropathy due to gastrointestinal amyloidosis, occurring in empyema].
abstract: On August 14, 2001, a 76-year-old woman with a history of rheumatoid arthritis was admitted to our hospital with fever, cough, dyspnea and diarrhea. On admission, her chest radiography showed pleural effusion on the right side, and thoracocentesis was used to diagnose empyema. The patient underwent pleural drainage and received antibiotics. Alpha-Streptococcus was detected in both aerobic and anaerobic cultures of the pleural effusion. After 2 weeks of therapy, her empyema had improved; but her diarrhea, which had started 1 week before admission, had worsened, and her hypoproteinemia had progressed. Examination of the fecal clearance of alpha-1-antitrypsin and biopsied rectal material revealed that the diarrhea was caused by protein-losing enteropathy due to gastrointestinal amyloidosis secondary to rheumatoid arthritis. The patient was treated with steroids, but developed an additional infectious disease and died on September 29, 2001. In this case, she suffered from various infectious diseases including empyema and fungus infections. It has been reported that protein-losing enteropathy accompanies abnormalities in the immune system, by the loss of immunoglobulins and lymphocytes from the gut. We therefore suspect that protein-losing enteropathy due to gastrointestinal amyloidosis caused this patient's empyema.
authors.affiliation: Department of Internal Medicine, Division of Respiratory Disease, Hyogo College of Medicine, Hyogo, 663-8501, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakagomi
authors.forename: Osamu
authors.initials: O
authors.lastname: Kitada
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyata
authors.forename: Kazumi
authors.initials: K
authors.lastname: Aragane
authors.forename: Taku
authors.initials: T
authors.lastname: Kodama
authors.forename: Kouzou
authors.initials: K
authors.lastname: Kuribayashi
authors.forename: Shoko
authors.initials: S
authors.lastname: Jin
authors.forename: Noriko
authors.initials: N
authors.lastname: Takenaka
authors.forename: Namiko
authors.initials: N
authors.lastname: Nagasawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Sugita
authors.forename: Tatuhito
authors.initials: T
authors.lastname: Nakae
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000150:complications; D004653:Empyema / Q000150:complications*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications*; D006801:Humans; D011504:Protein-Losing Enteropathies / Q000209:etiology*