Amyloidosis of the small intestine secondary to rheumatoid arthritis or juvenile rheumatoid arthritis: report of two cases

We report two cases of gastrointestinal amyloidosis, complicated with juvenile rheumatoid arthritis (JRA) in one and rheumatoid arthritis (RA) in the other. A 21-year-old woman, who had been suffering from JRA for the past 12 years, was transferred to our hospital due to intense pain in the epigastrium and back, diarrhea, high fever, and paralytic ileus. Treatment by corticosteroid, antibiotics protease inhibitor and total parenteral nutrition was not effective. Laparoscopic surgery was performed because of repeated melena followed by an episode of hypovolemic shock. The resected specimen of the ileum showed histologically marked amyloid deposition in the arteriolar walls. A 83-year-old man with RA for 14 years was admitted to our hospital with complaints of abdominal pain, nausea and diarrhea. He underwent an emergency operation for perforation of the ileum. The resected specimen revealed amyloid deposition and non-caseating granulomas. The fragility and impaired blood supply caused by amyloid deposition in the vascular walls may have terminated in the severe intestinal lesion. Further clinicopathological studies along this line are keenly desired in order to establish therapeutic modalities for gastrointestinal amyloidosis.