Title : Gastrointestinal amyloidosis in a 71-year old Filipino female - A case report
Abstract:
Introduction: Gastrointestinal (GI) amyloidosis is a rare and frequently underrecognized manifestation of systemic amyloidosis. Its presentation is often nonspecific, particularly in elderly patients, leading to delayed diagnosis. Histologic confirmation with Congo red staining remains the diagnostic standard. Early recognition is important to guide supportive management and maintain systemic therapy.
Main Concerns and Clinical Findings: We report a 71-year-old Filipino woman with cardiac amyloid light-chain (AL) amyloidosis undergoing chemotherapy with the ANDROMEDA protocol (daratumumab, bortezomib, cyclophosphamide, dexamethasone). She developed persistent reflux, epigastric discomfort, early satiety, and constipation. Initial endoscopy showed nonspecific findings. Biopsies from the stomach and ileum later revealed amyloid deposition in the lamina propria and vessel walls on Congo red staining, confirming GI involvement. Symptoms were managed conservatively using proton pump inhibitors, prokinetics, and mucosal protectants, with good control and no interruption of chemotherapy. She did not develop major complications such as bleeding, obstruction, or protein-losing enteropathy.
Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for GI amyloidosis in elderly patients with systemic AL amyloidosis who present with nonspecific GI symptoms. Diagnosis requires a combination of clinical suspicion, endoscopic evaluation, and histologic confirmation with Congo red staining. Early recognition allows for timely initiation of therapy, such as the Dara-VCD regimen, which can improve both hematologic response and organ function. Adherence to strict and regular follow-up is also essential in minimizing complications. Given the rarity of GI amyloidosis and its protean manifestations, this case contributes to the limited body of literature emphasizing the value of comprehensive evaluation and individualized treatment in achieving favorable outcomes.
