Spontaneous pneumoperitoneum: an unusual complication of systemic reactive AA amyloidosis secondary to rheumatoid arthritis.
We report a 71-year-old man with reactive AA amyloidosis secondary to rheumatoid arthritis who developed spontaneous pneumoperitoneum with intestinal pseudo-obstruction as an initial symptom. Severe deposition of amyloid in the intestinal wall was considered to play an important role in the pathogenesis of this unusual symptom. The patient has been successfully treated with total parenteral alimentation and intermediate-dose prednisolone (30 mg/day). Although pneumoperitoneum usually suggests gastrointestinal perforation requiring emergency surgery, conservative therapy should be seriously considered in amyloidosis-related cases with no associated peritonitis, since multiple vital organs are probably involved by severe amyloid deposition, thus increasing the risks of surgery.
Matsuda
Masayuki
M
Division of Rheumatology, Third Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. matsuda@hsp.md.shinshu-u.ac.jp
Nishikawa
Noriko
N
Okano
Tomomi
T
Hoshi
Kenichi
K
Suzuki
Akio
A
Ikeda
Shu-ichi
S
D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000209:etiology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D005753:Gastric Mucosa / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007418:Intestinal Pseudo-Obstruction; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011239:Prednisolone / Q000627:therapeutic use; D011859:Radiography; D000685:Serum Amyloid A Protein / Q000378:metabolism*
D005938:Glucocorticoids; D000685:Serum Amyloid A Protein; D011239:Prednisolone