만성 통풍결절 환자에서 발생한 위장관 아밀로이드증 1예
Gastrointestinal amyloidosis secondary to chronic tophaceous gout
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초록
저자 등은 체중감소, 구역, 구토, 설사, 손발의 종창으로 내원한 70세 만성 결절통풍 환자에서 발생한 이차성 위장관 아밀로이드증을 경험하였기에 문헌고찰과 함께 보고하는 바이다. 통풍 환자에서 아밀로이드증의 발생은 매우 드물지만, 조절되지 않은 만성 통풍결절 관절염 환자에서 지속적인 설사, 저알부민혈증이나 부종이 있는 경우 감별 진단으로 고려되어야 할 것으로 여겨진다.
Abstract
Secondary amyloidosis is associated with infectious, inflammatory, or neoplastic disorders. Gouty arthritis, unlike other forms of chronic inflammatory arthritis, is not usually associated with amyloidosis. A 70‐year‐old man was admitted because of generalized edema, anorexia, and diarrhea. He had been diagnosed with gouty arthritis 12 years earlier and took over-the-counter medication during acute attacks. The physical examination revealed multiple tophi on his ears, right hand, and right foot. No evidence of amyloidosis involving the heart or bone marrow was detected. Biopsy of the antrum, duodenum, ileum, and descending colon showed green birefringence with Congo red stain. Immunohistochemistry was strongly positive for amyloid A. We diagnosed him as having secondary gastrointestinal amyloidosis AA with chronic tophaceous gouty arthritis. Allopurinol was administered and oral prednisolone was increased. However, he died from septic shock 25 days after admission.
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