GASTROINTESTINAL AMYLOIDOSIS IN A PATIENT WITH IGG-KAPPA LIGHT-CHAIN MULTIPLE-MYELOMA - DIAGNOSTIC PROBLEMS DESPITE ADVANCED CHANGES

A 50-year-old man with an IgG-H Light chain multiple myelom stage IIIA , developed - in a phase of low disease activity, after 18 months of a n uncomplicated course - marked malabsorption syndrome with 20 kg weig ht loss, diarrhoea and meteorism. Although the H-2-breath test indicat ed intestinal bacterial colonisation, neither antibacterial treatment with trimethoprim/sulphamethoxazole and metronidazole nor prokinetic t reatment with cisapride (30 mg daily) and erythromycin (1 g twice dail y) improved the symptoms. Suspected amyloidosis was not demonstrable a t first, despite repeated step biopsies of stomach, duodenum and rectu m. Amyloidosis of the entire gastrointestinal tract was proven only by repeated biopsies deep into the submucosa. Despite treatment of the u nderlying disease with melphalan and prednisone (Alexanian's scheme) t he amyloidosis advanced further to involve liver, spleen, lung, kidney s and heart. The patient died, 2 years after diagnosis of the multiple myeloma, from recurrent pulmonary emboli due to atrial fibrillation.