Necrotizing angiitis of the small intestine related to AA-amyloidosis: A novel association

A 71-year-old man with intestinal pseudo-obstruction was found to have a di ffusely thickened adynamic small bowel with AA-amyloid in submucosal vessel s and muscularis propria, foreign body giant cell reaction to amyloid. and necrotizing angiitis. The mucosa was unremarkable. Immunostains demonstrate d numerous CD68+ monocyte/macrophages and CD8+ T cells associated with the amyloid deposits. The patient had no evidence of systemic vasculitis and no underlying cause for AA-amyloidosis was identified. Necrotizing angiitis c oexistent with amyloid angiopathy has been reported in brain and temporal a rteries, but nor in the gastrointestinal tract and not with AA-amyloid. The inflammatory cell infiltrates in this case are consistent with a foreign-b ody and/or cell-mediated immunologic reaction to AA-amyloid, although a rol e for these cells in amyloid formation cannot be excluded.