Ankylosing spondylitis with ulcerative colitis and amyloidosis

Benedek, Thomas G.; Zawadzki, Z

doi:10.1016/0002-9343(66)90137-9

Cited by 24 publications

(4 citation statements)

References 30 publications

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“…Ulceration of the colon has been described secondary to amyloid disease (7-1 1). Amyloid disease has been known to complicate regional enteritis, ulcerative colitis, (1 2, 13), psoriatic arthritis (1 5- 17), and ankylosing spondylitis (14). One other patient with Reiter's disease and amyloid of the colon has been described ( 5 ) , and in many ways his course was similar to that of this patient.…”

Section: Discussionmentioning

confidence: 63%

A fatal case of Reiter's disease complicated by amyloidosis

Caughey

Wakem

1973

Arthritis & Rheumatism

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The clinical course of an 18-year-old boy with Reiter's disease is described. Diarrhea occurred at times, as did occasional melena. Remission occurred after 6 months, but 3 months later, following a severe relapse involving the skin, the joints, and the bowel, paralytic ileus developed, and at laparotomy colectomy was performed. On the sixth postoperative day he died. The postmortem findings were of bronchopneumonia and widespread amyloidosis, including involvement of the bowel.Reiter's disease usually has a natural course, in the first attack, of 1 to 3 months, with a percentage of cases having recurrences in succeeding years. T h e prognosis is good for the overwhelming majority of patients (1). Death, when it has been reported in the early stages, has been due to massive gastric hemorrhage associated with gastric ulceration and necrosis of the submucosa (2,3) and in the late stages to aortic incompetence, heart block, and its complications (4). Only one report of amyloid complicating Reiter's disease and causing colitis and death has been found, and the case to be described has many features in common with it (5). CASE REPORT HistoryThe patient, an 18-year-old, single, European male was admitted to hospital in January 1967. H e had been well un- ti1 July 1966, when he had a bout of diarrhea lasting 2 months. During this time he had 6 loose bowel movements a day unassociated with the passage of blood and mucus. He received no treatment, the diarrhea ceased spontaneously, and he did not lose weight during this time.In October 1966, he became tired, anorexic, and listless. He developed lumbar back pain which necessitated leaving his occupation as a laborer for a logging firm to work as a salesman in a department store. In the second week of November his lower limbs became painful in both the muscles and joints (Figure 1). About this time he had sexual intercourse and a week later developed urethritis with a thick whitish discharge, dysuria, and midabdominal pain. He had last had sexual intercourse in March 1966.In early January 1967 he developed a painless bilateral conjunctivitis which was treated with penicillin. Both the conjunctivitis and urethritis settled within a few days.Seven days before admission a cow trod on his left instep. Two days later he developed arthritis of his left ankle. This was followed by rigors, sweating, and fever, and an exacerbation of his lumbosacral pain. The right ankle joint became hot, swollen, and tender, and he developed a pharyngitis; he was given penicillin, aspirin, and indomethacin. Two days after this he passed 5 to 10 black stools per day for 2 days. On the day before admission his knees became acutely tender and swollen, and it was for this reason he was admitted to hospital.H e had had no significant illnesses in the past. There was no family history of joint disease or psoriasis. Physical ExaminationThe patient was wasted, febrile (39' C), and had a polyarthritis involving the shoulders, elbows, wrists, metacarpophalangeal joints, hips, knees, ankles, and feet. There ...

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Section: Discussionmentioning

confidence: 63%

A fatal case of Reiter's disease complicated by amyloidosis

Caughey

Wakem

1973

Arthritis & Rheumatism

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“…We have, therefore, arranged the cases according to the clinical diagnoses into pericollagen and perireticulin types. Twelve cases were thus presumed to be of the perireticulin type (Adlesberg and Schein, 1947;Jensen, Bargen, and Baggenstoss, 1950;Bassett, Adams, Goldman, and Fishkin, 1952;Golden, 1954;Mandelbaum and Bryk, 1955;Beddow and Tilden, 1960;Gelderman, Levine, and Arndt, 1962;Targgart, Trump, Lagunoff, and Eschbach, 1963;Shibolet and Gafni, 1964;Benedek and Zawadzki, 1966). In all of these 12 cases amyloid was found in blood vessels and in 10 in the mucosa also.…”

Section: Discussionmentioning

confidence: 99%

Deposition of amyloid in the gastrointestinal tract.

Gilat¹,

Revach²,

Sohar³

1969

Gut

136

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“…The association of ankylosing spondylitis and amyloidosis is well documented (9)(10)(11)(12)(13)(14), but the association of systemic lupus erythematosus, ankylosing spondylitis, and amyloidosis has not been described.…”

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confidence: 99%

Systemic Lupus Erythematosus and Amyloidosis

Webb

Segura

Cervantes

et al. 1979

Arthritis & Rheumatism

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Amyloidosis can occur in association with a series of other processes, including connective tissue disease; amyloid deposition has been found in rheumatoid arthritis, dermatomyositis, scleroderma, and periarteritis nodosum. But among the many cases published only four authors describe systemic lupus erythematosus (SLE) and amyloidosis (1-4). We report a case of association of SLE and amyloidosis in a patient in whom radiologic and serologic findings compatible with ankylosing spondylitis were discovered.Case report. JFR, a 62-year-old white woman, was admitted to the hospital with acute pyelonephritis. Her history was not significant except for isolated episodes of noninflammatory arthralgia of the large joints with morning stiffness for the last 25 years, occasional Raynaud's syndrome of both hands, and more recently, mild congestive heart failure. Physical examination on admission revealed mild congestive heart failure and tenderness on deep pressure in both costovertebral areas; blood-pressure was 130/70 mm Hg, pulse 85 and regular, temperature 38.4OC; chest x-ray film showed basal platelike atelectasis, diaphragmatic elevation, and a widened left costophrenic angle. Hemoglobin was 6.5 gm/ 100 ml; there was anisopoikilocytosis; WBC was 10,100; differential showed 3 1% stab neutrophils; sedimentation rate was 83 mm/hour; serum iron was 18 pg/ 100 ml and iron-binding saturation 13%. BUN was 49 mg/100 ml, creatinine 2.1 mg/100 ml with an endogenous creatinine clearance of 23.6 ml/minute; urine sediment showed 50 leukocytes and 5 erythrocytes per high power field. Electrolytes, fasting blood sugar, SGOT, SGPT, LDH, lipids, bilirubin, coagulation tests, ECG, barium meal and enema, and an intravenous pyelogram were normal. Serum protein electrophoresis showed a broad-based increase in the gammaglobulin (22 gm/ liter) and a decrease in the albumin (21 gm/liter) region; immunoglobulin A and M were normal, but IgG was 2560 mg/100 ml (normal: 600-1500 mg/100 ml); proteinuria oscillated between 1960 and 7530 mg/liter. Blood and urine cultures were positive for E coli and treatment with trimethoprine-sulfametoxazole was begun. A bone marrow examination showed a decreased red cell series, 1% sideroblasts, and decreased reticuloendothelial iron; a search for occult bleeding from the gastrointestinal tract was slightly positive once and negative on two occasions; we were unable to explain further the cause of this iron deficient anemia. Antinuclear antibodies were positive at 1/2000 and exhibited a speckled pattern; anti-DNA antibodies were positive at 1 /200 (by radioimmunoassay); rheumatoid factor, cryoglobulins, and the LE-cell phenomenon were positive; syphilis serologic tests, cryofibrinogen, Coombs test, and antimuscle antibodies were negative; serum complement was reduced to a C'3 of 32 mg/100 ml (normal: 80-140), C'4 of 8 mg/100 ml (normal 20-50) and CH50 of 100 units (normal: 400-700). A kidney biopsy revealed by optic microscopy extensive renal amyloidosis and lesions suggestive of necrotizing arteritis; glomerula...

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Ankylosing spondylitis with ulcerative colitis and amyloidosis

Cited by 24 publications

References 30 publications

A fatal case of Reiter's disease complicated by amyloidosis

A fatal case of Reiter's disease complicated by amyloidosis

Deposition of amyloid in the gastrointestinal tract.

Systemic Lupus Erythematosus and Amyloidosis

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