A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure

Seonghun Hong; Young-Woon Chang; Jong Kyu Byun; Min Je Kim; Jung Min Chae; Sun Hee Park; Chi Hyuk Oh; Yong-Koo Park

doi:10.4166/kjg.2015.66.4.227

Journal List > Korean J Gastroenterol > v.66(4) > 1007431

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Hong, Chang, Byun, Kim, Chae, Park, Oh, and Park: A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure

Case Report

Korean J Gastroenterol 2015;66(4):227-230.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.4.227

A Case of Primary Gastric Amyloidosis with Fulminant Heart Failure

Seonghun Hong, Young-Woon Chang, Jong Kyu Byun, Min Je Kim, Jung Min Chae, Sun Hee Park, Chi Hyuk Oh, Yong-Koo Park¹

Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea

¹Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea

Correspondence to: Young-Woon Chang, Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea. Tel: +82-2-958-8200, Fax: +82-2-968-1848, E-mail: cywgi@chol.com

Received 26 March 2015 Revised 30 April 2015 Accepted 15 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Amyloidosis, Stomach, Heart failure

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Fig. 1.

Endoscopic findings of the stomach. (A) On greater curvature and (B) lesser curvature of the stomach, marked mucosal atrophy and diffuse granular surface appearances are noted along with mucosal friability.

Fig. 2.

CT scan of the thorax. Two thrombi are present in the right atrium and left atrium appendage (arrows). Pleural effusion is also observed.

Fig. 3.

Echocardiography. Significant hypertrophy and bright twinkling echogenecity are observed. A thrombus is also noted in the left atrium (arrow).

Fig. 4.

Cardiac MRI. On delayed enhanced image, abnormal global subendocardial enhancement is shown.

Fig. 5.

Microscopic findings. (A) Profound eosinophilic masses are noted in lamina propria (H&E, ×100). (B) Congo-red stain reveals pink red deposits (×200). (C) The yellow-green bifringence of the deposits is observed by polarizing microscope (×200).

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