Vnitr Lek 2008, 54(11):1106-1110

Persistent diarrhoea, hypotension, polyneuropathy

R. Sýkora¹, J. Raděj¹, I. Novák¹, A. Kroužecký¹, J. Mareš¹, I. Irová², Š. Hadravská², J. Chvojka¹, T. Karvunidis¹, T. Maňáková², M. Matějovič^1,*

¹ I. interní klinika Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Martin Matějovič, Ph.D.

² Šiklův patologicko-anatomický ústav Lékařské fakulty UK a FN Plzeň, přednosta prof. MUDr. Michal Michal

We present a case report of a 59-year-old man with a history of arterial hypertension and excision of malignant melanoma. He was admitted to the hospital because of two months history of diarrhoea, weight loss and circulatory collapse. In addition, the patient suffered from marked vegetative instability with symptomatic hypotension, polyneuropathy and progression of renal insufficiency, without proteinuria. Complex examination did not reveal neoplasms, endocrine, autoimmune, infectious or neurodegenerative disorders. A serial biopsy of colon failed to provide a clue to the diagnosis. However, AA amyloidosis was found on the kidney biopsy. Neither chronic inflammation nor malignancy was revealed and, hence, no causal treatment could have been established. The patient died from multiple organ failure. The autopsy confirmed systemic AA amyloidosis. The triad consisting of diarrhoea, polyneuropathy and hypotension should rise the suspicion on amyloidosis.

Keywords: amyloidosis; biopsy; hypotension; polyneuropathy; diarrhoea; renal insufficiency

Received: May 12, 2008; Accepted: August 18, 2008; Published: November 1, 2008  Show citation