Intestinal obstruction and gastrointestinal bleeding due to systemic amyloidosis in a woman with occult plasma cell dyscrasia

A 60-year-old woman presented to our hospital with repeated vomiting. Upper gastrointestinal endoscopy revealed a 1 cm diameter ulcer with clean base on the roof of the gastric antrum. Histological examination of gastric biop sies revealed abundant amorphous eosinophilic deposits in the submucosa. Co ngo red stain for amyloid was positive. A barium follow-through study revea led a mass in the jejunum causing incomplete obstruction. Urine for Bence J ones protein was negative. Serum protein electrophoresis did not reveal any abnormal band and serum immunoelectrophoresis did not detect any monoclona l immunoglobulin. Bone marrow examination, however, revealed an increased p roportion of plasma cells. Subsequent immunohistochemical staining demonstr ated monoclonal lambda light chains in the marrow plasma cells, thereby con firming a plasma cell dyscrasia, Amyloidosis involving the gastrointestinal tract can produce a wide variety of non-specific symptoms and signs. A hig h index of suspicion is necessary to arrive at an early diagnosis. Manageme nt consists of supportive therapy for the gastrointestinal tract as well as treatment of the underlying condition. Eur J Gastroenterol Hepatol 11:681- 685. (C) 1999 Lippincott Williams & Wilkins.