Hepatic Involvement In Systemic Amyloidosis – A Case Report

A 52 year old woman presented at the gastroenterology clinic of University of Nigeria Teaching Hospital Enugu with a 3-month history of pruritus, right upper abdominal pain, easy satiety and weight loss. She had been treated in a peripheral hospital 2 years earlier for epigastic pain. The main findings on physical examination were emaciation, scanty axillary hair, palmer erythema and hepatomegaly. Urine examination showed marked proteinuria. Serum alkaline phosphatase was markedly elevated. Histological examination of biopsy specimen of the liver showed marked hyaline-like amorphous perivascular and extravascular deposition, which proved to be amyloid with Congo red stain. The patient later developed persistent vomiting and had one episode of haematemesis. Barium meal showed severe deformity and scarring of the duodenal bulb. Gastrojenostomy was carried out but the patient died 3 hours after surgery from severe haematemesis. We conclude that the patients had amyloid infiltration of the liver with probable involvement of the kidneys and upper gastrointestinal tract Amyloidosis should be suspected in any patient with unexplained hepatopathy and proteinuria KEY WORDS: Amyloidosis, hepatic, cholestasis. Nigerian Journal of Clinical Practice Vol.7(2) 2004: 102-10