[A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure].
A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Seonghun
S
Hong
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Young Woon
YW
Chang
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Jong Kyu
JK
Byun
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Min Je
MJ
Kim
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Jung Min
JM
Chae
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Sun Hee
SH
Park
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Chi Hyuk
CH
Oh
Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea.
Yong Koo
YK
Park
D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D007145:Immunoglobulin kappa-Chains / Q000097:blood / Q000652:urine; D007146:Immunoglobulin lambda-Chains / Q000097:blood / Q000652:urine; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013272:Stomach Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D013927:Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains
Amyloidosis; Heart failure; Stomach