Spontaneous pneumoperitoneum: an unusual complication of systemic reactive AA amyloidosis secondary to rheumatoid arthritis

Amyloid. 2003 Mar;10(1):42-6. doi: 10.3109/13506120308995257.

Abstract

We report a 71-year-old man with reactive AA amyloidosis secondary to rheumatoid arthritis who developed spontaneous pneumoperitoneum with intestinal pseudo-obstruction as an initial symptom. Severe deposition of amyloid in the intestinal wall was considered to play an important role in the pathogenesis of this unusual symptom. The patient has been successfully treated with total parenteral alimentation and intermediate-dose prednisolone (30 mg/day). Although pneumoperitoneum usually suggests gastrointestinal perforation requiring emergency surgery, conservative therapy should be seriously considered in amyloidosis-related cases with no associated peritonitis, since multiple vital organs are probably involved by severe amyloid deposition, thus increasing the risks of surgery.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amyloidosis / complications*
  • Amyloidosis / etiology
  • Amyloidosis / therapy
  • Arthritis, Rheumatoid / complications*
  • Arthritis, Rheumatoid / drug therapy
  • Gastric Mucosa / pathology
  • Glucocorticoids / therapeutic use
  • Humans
  • Intestinal Pseudo-Obstruction
  • Male
  • Middle Aged
  • Pneumoperitoneum / diagnostic imaging
  • Pneumoperitoneum / etiology*
  • Pneumoperitoneum / therapy
  • Prednisolone / therapeutic use
  • Radiography
  • Serum Amyloid A Protein / metabolism*

Substances

  • Glucocorticoids
  • Serum Amyloid A Protein
  • Prednisolone