Amyloid induced single ischaemic sigmoid-colons ulcer in a patient with rheumatic arthritis

The single ulcer of the colon is a rarity. It occurs usually in the rectum. We have found a single ulcer in the sigma-descendens border of a patient suffering in rheumatic arthritis (RA) for 31 years.

52 years old female has a sero-positive RA from the age of twenty with serious destructions affecting initially her knees and later her little joints. Two years later bilateral synoviectomy of her knees, ten years later bilateral modular knee prothesis, in the thirteenth year right side resection of the head of radius bone, in the eighteenth year left and than right side thigh-bone neck fracture was operated on. In the twenty-fourth year of her disease serious osteoporosis, chronic anaemia, Helicobacter pylori negative erosive gastritis was revealed. The therapy based on systemic and/or local steroid and NSAID, and as disease modifying therapy mainly gold, and in the last fifteen years methotrexate.

After thirty-one year of her RA progressively serious iron deficiency microcytic anaemia developed. Stool Haemo-screen was repeatedly positive. Sternum smear proved increased myelopoesis. Gynaecological investigation and transabdominal US were negative. A 4-cm broad, half wall spreading haemophilic, ischemic single ulcer of the sigmoid colon was observed during an otherwise negative colonoscopy. The biopsies proved to be ischemic ulcer with chronic colitis histologically. In the wall of the submucosal vessels double reflectioning amyloid was demonstrated with congo red.

Secundary amyloidosis – appearing in the 5% of the RA patients – led to the development of the single ischemic sigmoid ulcer.