Jejunal amyloidosis: a rare case presented with sudden weight loss and altered bowel habits

Abstract

Amyloidosis is a multisystem disease characterized by the extracellular deposition of abnormal protein fibrils in various tissues and organs. It is a systemic disease mainly affecting the kidneys, liver, and spleen. In the GI tract, the duodenum is most commonly involved, followed by the stomach. We came across a relatively unusual case of jejunal amyloidosis, where the presentation was with weight loss, abdominal pain, and changes in bowel habits. Radiological findings were non-specific, such as thickening of small bowel loops and small nodular bowel wall lesions, etc. Endoscopic features were also not characteristic of any particular disease entity. Therefore, it was hard to narrow down the differential diagnosis based on endoscopy and clinic-radiological grounds. The diagnosis remained a mystery until the outcome of the final histopathology report. This case study will facilitate readers in considering this entity in the differential list if they encounter mimicking clinical and/or radiological features.

Figure 1.

(A-D) Axial and coronal reformatted images of CT after oral and I/V contrast administration shows thickening of the folds with some folds demonstrating polypoidal appearances and sub-centimeter reactive nodes in the small bowel mesentery.

Figure 2.

(A) Nodular bowel wall thickening. (B) Segmental Proximal small bowel involvement. (C) Nodular small bowel wall enhancement. (D) Diffusion restriction.

Figure 3.

PET CT (Nov 2023) showed no abnormal FDG uptake in involved bowel loops.

Figure 4.

(A-H) Endoscopy images.

Figure 5.

(A-C) Histopathology images.