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- W2979700425 abstract "INTRODUCTION: Amyloidosis refers to group of conditions caused by a build-up of amyloid fibrils in organs and tissues throughout the body. We present a very rare case of localized amyloidosis of the stomach presenting with an upper gastrointestinal bleeding (UGIB) due to arteriovenous malformation (AVM). CASE DESCRIPTION/METHODS: An 81-year-old female with past medical history significant for hypertension presented with hematemesis of one day duration. Vital signs were within normal limits. Physical exam was significant for epigastric tenderness. Initial lab work revealed hemoglobin 8.4 g/dL, mcv 83 fL, wbc 11.2 K/cm, platelets 513 K/cmm. Complete metabolic panel was within normal limits. Esophagogastroduodenoscopy (EGD) demonstrated oozing of blood on contact with air insufflation from the lesser curvature, body and fundus of the stomach with normal duodenum. Interventional radiology angiogram and computed tomography angiography were performed and were unable to localize source of bleeding. EGD was attempted four days later and recurrent oozing of blood on mucosal contact with air insufflation occurred. She was subsequently placed on total parenteral therapy (TPN) and sucralfate for ten days to help heal the cause of the inflammation. A third endoscopy showed similar findings. Thus, biopsies were taken. Hemoglobin remained stable with no recurrent hematemesis episodes and patient was discharged on PPI, sucralfate and liquid diet. CD34 staining on biopsy reveals dilated and congested blood vessels suggestive of AVM and special stain (Congo Red) portraying apple green birefringence confirming diagnosis of amyloidosis (Figures 1 and 2). Serum protein electrophoresis exhibited gamma globulin spike portraying AL amyloidosis. DISCUSSION: A single case of intraabdominal arteriovenous malformation and localized amyloidosis of an abdominal mass has been reported. This is the first reported case of localized gastric amyloidosis with AVM presenting with an UGIB. The association between AVM and amyloidosis is hypothesized to be due to amyloid proteins deposition predilection around leaky vasculatures, which was proven in mice. AVM causes amplified plasma flow and increased amyloid deposition leading to vessel friability and ischemia, ultimately resulting in mucosal ulcerations with delayed healing. This is our postulated mechanism as to why our patient had persistent gastric ulcer bleeding not amenable to multiple therapeutic/follow-up EGDs." @default.
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- W2979700425 date "2019-10-01" @default.
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- W2979700425 title "2787 Gastric Amyloidosis With Arteriovenous Malformation: A Rare Etiology of Upper GI Bleeding" @default.
- W2979700425 doi "https://doi.org/10.14309/01.ajg.0000600680.80260.c0" @default.
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