Successful treatment of protein-losing enteropathy due to AA amyloidosis with octreotide in a patient with rheumatoid arthritis
Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. This excessive protein loss across the gut epithelium can be explained by several mechanisms, such as augmentation of the intestinal mucosal capillary permeability, mucosal...
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Published in | Modern rheumatology Vol. 23; no. 2; pp. 406 - 411 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Japan
Springer Japan
01.03.2013
Informa Healthcare |
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Abstract | Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. This excessive protein loss across the gut epithelium can be explained by several mechanisms, such as augmentation of the intestinal mucosal capillary permeability, mucosal disruption, intestinal or mesenteric vasculitis, and lymphangiectasia. However, these pathophysiologic alterations of the gut are closely linked to the underlying cause, and primary treatment for PLE should be directed at the underlying condition. Here, we report a female patient with rheumatoid arthritis who developed severe PLE due to AA amyloidosis and was successfully treated with octreotide. She had been suffered from rheumatoid arthritis for 18 years, and her arthritic symptoms at the time of presentation were not definite but manifested as severe diarrhea and general edema with hypoalbuminemia. PLE due to gastrointestinal amyloidosis was confirmed by increased fecal α
1
-antitrypsin clearance and a colonoscopic biopsy that was positive for amyloid deposits. The diarrhea dissipated with conventional treatment, but the general edema resolved only after introducing a long-acting somatostatin analog (octreotide), along with a gradual recovery of the serum albumin level. This case teaches us that in the case of PLE due to AA amyloidosis that is refractory to conventional treatment, the administration of octreotide should be considered. |
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AbstractList | Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. This excessive protein loss across the gut epithelium can be explained by several mechanisms, such as augmentation of the intestinal mucosal capillary permeability, mucosal disruption, intestinal or mesenteric vasculitis, and lymphangiectasia. However, these pathophysiologic alterations of the gut are closely linked to the underlying cause, and primary treatment for PLE should be directed at the underlying condition. Here, we report a female patient with rheumatoid arthritis who developed severe PLE due to AA amyloidosis and was successfully treated with octreotide. She had been suffered from rheumatoid arthritis for 18 years, and her arthritic symptoms at the time of presentation were not definite but manifested as severe diarrhea and general edema with hypoalbuminemia. PLE due to gastrointestinal amyloidosis was confirmed by increased fecal α1-antitrypsin clearance and a colonoscopic biopsy that was positive for amyloid deposits. The diarrhea dissipated with conventional treatment, but the general edema resolved only after introducing a long-acting somatostatin analog (octreotide), along with a gradual recovery of the serum albumin level. This case teaches us that in the case of PLE due to AA amyloidosis that is refractory to conventional treatment, the administration of octreotide should be considered. Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. This excessive protein loss across the gut epithelium can be explained by several mechanisms, such as augmentation of the intestinal mucosal capillary permeability, mucosal disruption, intestinal or mesenteric vasculitis, and lymphangiectasia. However, these pathophysiologic alterations of the gut are closely linked to the underlying cause, and primary treatment for PLE should be directed at the underlying condition. Here, we report a female patient with rheumatoid arthritis who developed severe PLE due to AA amyloidosis and was successfully treated with octreotide. She had been suffered from rheumatoid arthritis for 18 years, and her arthritic symptoms at the time of presentation were not definite but manifested as severe diarrhea and general edema with hypoalbuminemia. PLE due to gastrointestinal amyloidosis was confirmed by increased fecal α 1 -antitrypsin clearance and a colonoscopic biopsy that was positive for amyloid deposits. The diarrhea dissipated with conventional treatment, but the general edema resolved only after introducing a long-acting somatostatin analog (octreotide), along with a gradual recovery of the serum albumin level. This case teaches us that in the case of PLE due to AA amyloidosis that is refractory to conventional treatment, the administration of octreotide should be considered. Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. This excessive protein loss across the gut epithelium can be explained by several mechanisms, such as augmentation of the intestinal mucosal capillary permeability, mucosal disruption, intestinal or mesenteric vasculitis, and lymphangiectasia. However, these pathophysiologic alterations of the gut are closely linked to the underlying cause, and primary treatment for PLE should be directed at the underlying condition. Here, we report a female patient with rheumatoid arthritis who developed severe PLE due to AA amyloidosis and was successfully treated with octreotide. She had been suffered from rheumatoid arthritis for 18 years, and her arthritic symptoms at the time of presentation were not definite but manifested as severe diarrhea and general edema with hypoalbuminemia. PLE due to gastrointestinal amyloidosis was confirmed by increased fecal α1-antitrypsin clearance and a colonoscopic biopsy that was positive for amyloid deposits. The diarrhea dissipated with conventional treatment, but the general edema resolved only after introducing a long-acting somatostatin analog (octreotide), along with a gradual recovery of the serum albumin level. This case teaches us that in the case of PLE due to AA amyloidosis that is refractory to conventional treatment, the administration of octreotide should be considered. [PUBLICATION ABSTRACT] |
Author | Jung, Young-Hee Cho, Chul-Soo Baek, In-Woon Kim, Ki-Jo Shin, Jin-Kyeong Bae, Myoung-Nam |
Author_xml | – sequence: 1 givenname: Jin-Kyeong surname: Shin fullname: Shin, Jin-Kyeong organization: Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea – sequence: 2 givenname: Young-Hee surname: Jung fullname: Jung, Young-Hee organization: Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea – sequence: 3 givenname: Myoung-Nam surname: Bae fullname: Bae, Myoung-Nam organization: Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea – sequence: 4 givenname: In-Woon surname: Baek fullname: Baek, In-Woon organization: Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea – sequence: 5 givenname: Ki-Jo surname: Kim fullname: Kim, Ki-Jo email: md21c@catholic.ac.kr organization: Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea – sequence: 6 givenname: Chul-Soo surname: Cho fullname: Cho, Chul-Soo organization: Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea |
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Cites_doi | 10.1210/en.136.9.4133 10.1016/j.jbspin.2010.09.020 10.1007/s00296-008-0590-z 10.1007/s00296-009-1205-z 10.1080/13506120500032725 10.1080/13506120802524676 10.1002/art.24735 10.1136/pmj.77.913.686 10.1016/S0140-6736(00)05252-1 10.1111/j.1572-0241.1999.929_b.x 10.1056/NEJMoa070265 10.1002/(SICI)1521-4141(199908)29:08<2454::AID-IMMU2454>3.0.CO;2-H 10.1056/NEJMra023144 10.1111/j.1572-0241.2007.01669.x 10.1191/0961203302lu152cr 10.1046/j.1365-2036.2001.01114.x 10.1097/00002281-200101000-00011 10.1007/BF01213300 10.1136/ard.56.9.535 10.1210/jc.84.8.2942 10.1016/S1297-319X(02)00449-9 10.3346/jkms.2004.19.3.466 |
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Keywords | Octreotide Amyloidosis Protein-losing enteropathy Rheumatoid arthritis |
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Snippet | Protein-losing enteropathy (PLE) is a rare syndrome of gastrointestinal protein loss that may complicate a variety of diseases. This excessive protein loss... |
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SubjectTerms | Aged Amyloidosis - complications Arthritis, Rheumatoid - complications Case Report Colonoscopy Female Gastrointestinal diseases Humans Medical treatment Medicine Medicine & Public Health Octreotide - therapeutic use Orthopedics Protein-Losing Enteropathies - drug therapy Protein-Losing Enteropathies - etiology Proteins Rheumatoid arthritis Rheumatology Treatment Outcome |
Title | Successful treatment of protein-losing enteropathy due to AA amyloidosis with octreotide in a patient with rheumatoid arthritis |
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