Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Case Report Volume 5 Issue 4

Amyloid Vasculopathy Revealed by Episodes of Severe Arterial Hypotension Complicating Crohn's Disease

K El Montacer1*, W Hliwa1, Ri Seydou1, F Haddad1, FZ El Rhaoussi1, M Tahiri1, A Bellabah1, W Badre1 and M Regragui2

1Hepato-Gastroenterology Department of the University Hospital Center IBN ROCHD of Casablanca, Morocco
2Anatomopathology Department of the University Hospital Center IBN ROCHD of Casablanca, Morocco

*Corresponding Author: K El Montacer, Hepato-Gastroenterology Department of the University Hospital Center IBN ROCHD of Casablanca, Morocco.

Received: November 10, 2021; Published: March 04, 2022

Abstract

Background: Renal failure secondary to AA amyloidosis is a common cause of death among patients with untreated Crohn's disease. Once amyloid deposits set in, they are irreversible; however, controlling the inflammation limits the progression of tissue damage and stabilizes the disease.

Aim of the study: To describe the case of Crohn's disease with a delayed diagnosis reaching complication stage: renal and vascular amyloidosis with a poor prognosis, in order to make practitioners aware of the importance of systematic screening for this severe complication and the establishment as soon as possible of a specific therapeutic strategy aimed at controlling inflammation and slowing progression to end-stage chronic renal disease.

Case report: A 50years old male patient diagnosed, simultaneously, after 20 years of symptom progression, with stenosing ileocolic Crohn's disease complicated by systemic AA amyloidosis revealed by renal failure and episodes of vasoplegia. Ileo-caecal resection and control of inflammation with steroids and immunosuppressive therapy resulted in stabilization of renal status and decreased frequency of orthostatic hypotension episodes.

Conclusion: Screening for proteinuria and impaired renal function in patients with chronic inflammatory diseases, particularly Crohn's disease, allows early diagnosis of secondary amyloidosis. Although no treatment has been proven effective for the reversibility of amyloid deposits; control of inflammation seems to stop amyloidogenesis and consequently limits the progression of organ dysfunction.

Keywords: Crohn's Disease; Arterial Hypotension; AA Amyloidosis; Immunosuppressant

References

  1. Sharma P., et al. “Secondary systemic amyloidosis in inflammatory bowel disease: a nationwide analysis”. Annals of Gastroenterology5 (2017): 504.
  2. Momtaz M., et al. “Patterns of renal involvement in a cohort of patients with inflammatory bowel disease in Egypt”. Acta gastro-enterologica Belgica 81 (2018): 381-386.
  3. Moschcowitz E. “The clinical aspects of amyloidosis”. Annals of Internal Medicine 10 (1936): 73-89.
  4. Basturk T., et al. “Crohn's disease and secondary amyloidosis: early complication? A case report and review of the literature”. Journal of Renal Care3 (2009): 147-150.
  5. Guardiola-Arévalo A., et al. “Amyloidosis and Crohn’s disease”. Revista Espanola de Enfermedades Digestivas 5 (2011): 268-274.
  6. Wester AL., et al. “Secundary amyloidosis in inflammatory bowel disease: a study of 18 patients admitted to Rikshospitalet University Hospital, Oslo, from 1962 to 1998”. Inflammatory Bowel Diseases 7 (2001): 295-300.
  7. Tosca Cuquerella J., et al. “Amyloidosis in inflammatory bowel disease: a systematic review of epidemiology, clinical features, and treatment”. Journal of Crohn's and Colitis10 (2016): 1245-1253.
  8. Barahona-Correa JE., et al. “Renal Amyloidosis and Crohn Disease”. Ochsner Journal3 (2021): 291-295.
  9. Zhao L., et al. “Spectrum and prognosis of renal histopathological lesions in patients with inflammatory bowel disease: a cross-sectional study from a single center in China”. Clinical and Experimental Medicine (2021): 1-7.
  10. Uda H., et al. “Two distinct clinical courses of renal involvement in rheumatoid patients with AA amyloidosis”. The Journal of Rheumatology8 (2006): 1482-1487.
  11. Falck HM., et al. “Predominantly vascular amyloid deposition in the kidney in patients with minimal or no proteinuria”. Clinical Nephrology3 (1983): 137-142.
  12. Hazenberg BP., et al. “Diagnostic performance of 123I-labeled serum amyloid P component scintigraphy in patients with amyloidosis”. The American Journal of Medicine 119 (2006): 355.e15-24.
  13. Brunger AF., et al. “Causes of AA amyloidosis: a systematic review”. Amyloid 1 (2020): 1-12.
  14. Blesl A., et al. “Successful Pregnancies After Regression of AA Amyloidosis by Anti-inflammatory Therapy in Chronic Active Crohn’s Disease”. Digestive Diseases and Sciences9 (2020): 2730-2734.
  15. Basturk T., et al. “Crohn's disease and secondary amyloidosis: early complication? A case report and review of the literature”. Journal of Renal Care3 (2009): 147-150.
  16. Park YK., et al. “Systemic amyloidosis with Crohn's disease treated with infliximab”. Inflammatory Bowel Diseases3 (2008): 431-432.
  17. Sattianayagam PT., et al. “Inflammatory bowel disease and systemic AA amyloidosis”. Digestive Diseases and Sciences6 (2013): 1689-1697.

Citation

Citation: K El Montacer., et al. “Amyloid Vasculopathy Revealed by Episodes of Severe Arterial Hypotension Complicating Crohn's Disease". Acta Scientific Gastrointestinal Disorders 5.4 (2022): 03-06.

Copyright

Copyright: © 2022 K El Montacer., et al.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate35%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is April 30th, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US