Emerging from the shadows: A rare case of gastrointestinal AL amyloidosis presenting as hematemesis

Ali Jaan; Zouina Sarfraz; Joel McFarland; Patrick Okolo; Karin Dunnigan; Jason Gutman

doi:10.1080/08998280.2023.2257113

Emerging from the shadows: A rare case of gastrointestinal AL amyloidosis presenting as hematemesis

Proc (Bayl Univ Med Cent). 2023 Sep 25;36(6):758-760. doi: 10.1080/08998280.2023.2257113. eCollection 2023.

Authors

Ali Jaan¹, Zouina Sarfraz², Joel McFarland³, Patrick Okolo³, Karin Dunnigan³, Jason Gutman³

Affiliations

¹ Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.
² Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan.
³ Department of Gastroenterology, Rochester General Hospital, Rochester, New York, USA.

Abstract

We document a unique presentation of light chain (AL) amyloidosis in a 62-year-old man exhibiting as acute hematemesis and chronic abdominal discomfort. Esophagogastroduodenoscopy disclosed marked thickening of gastric and duodenal folds, gastroduodenal nodularity, and friable ulcerations. Biopsy confirmed amyloidosis. Subsequent investigations ratified a diagnosis of systemic AL amyloidosis with cardiac involvement. Initiation of the cyclophosphamide, bortezomib, and dexamethasone (CyBorD) regimen, along with tafamidis and doxycycline for cardiac pathology, led to substantial improvement of abdominal symptoms. This case highlights the variability in amyloidosis presentations and the importance of early diagnosis.

Keywords: AL amyloidosis; CyBorD regimen; esophagogastroduodenoscopy; gastrointestinal manifestations; hematemesis.