The beneficial effect of continuous jejunal feeding in a patient with amyloidosis and severe gastrointestinal hypomotility

Background: Amyloidosis is a rare systemic disorder characterized by the deposition of amyloid protein in several organs. Although it may appear as a primary disorder, its secondary form – developing on the basis of a malignant disease, a chronic infections or inflammation is more frequent. The authors present the case of a 58-year-old woman with amyloidosis and severe gastrointestinal hypomotility.

Case report: The patient was admitted with a12 month history of nausea, vomiting (2000–3000ml gastric retention), weight loss (about 20kg) and macroglossia. The laboratory tests showed hyponatraemia, hypokalaemia, elevated AP and GGT levels, and iron-deficiency anemia. The abdominal X-ray proved significant gastric retention. The stomach was drained through a nasogastric tube, and the patient received parenteral electrolyte support. Following lingual biopsy and gastroduodenoscopy, the histological examinations demonstrated AA amyloid deposits (Congo red staining) both in the tongue and in the stomach. An increased number of CD 68-positive polyclonal plasma cells with lambda and kappa chain deposits were detected by immune fluorescence microscopy. Echocardiography and abdominal computed tomography indicated the involvement of the heart, the esophagus, the stomach and the small bowels. The patient was further evaluated to exclude carcinomas, chronic infections and autoimmune diseases as causes of the amyloidosis. The bone marrow biopsy showed an excessive quantity of CD 38-positive matured plasma cells as the sign of multiple myeloma. Oradexone and colchicine treatment was started. The macroglossia improved, but oral feeding attempts repeatedly failed as a consequence of the severe gastrointestinal hypomotility. Percutaneous endoscopic jejunostomy was performed, and continuous jejunal feeding was applied. The patient progressively normalized, gained weight and was discharged.

Conclusion: This case indicates the beneficial effects of continuous enteral feeding in a patient with severe gastrointestinal hypomotility and malnutrition caused by secondary amyloidosis.