title: Systemic amyloidosis presenting as chronic diarrhea in a patient with ankylosing spondylitis.
abstract: Secondary (AA) amyloidosis is a disease that is caused by systemic deposition of amyloid fibrils. Circulating serum amyloid A protein is an acute phase reactant and levels are therefore high during inflammatory states. Chronic elevation of serum amyloid A levels results in accumulation and deposition in various organs, leading to organ dysfunction. Unless the inciting inflammatory state can be controlled, the subsequent development of amyloidosis diminishes patient survival. We report a case of systemic amyloidosis that presented primarily as chronic diarrhea in a patient with ankylosing spondylitis. Unfortunately for the patient, the diagnosis of amyloidosis was delayed for years despite encounters with multiple physicians. Early medical intervention to control chronic inflammation is imperative and could prevent morbidity and mortality related to the development of secondary amyloidosis. Consideration of amyloidosis as a diagnosis in patients who have chronic uncontrolled inflammatory conditions is also important in preventing poor outcomes related to this disease.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Zsuzsanna H
authors.initials: ZH
authors.lastname: McMahan
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Sailors
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Olsen
mesh_terms: D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003967:Diarrhea / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha