與多發性骨髓瘤相關的類澱粉蛋白沉著症引致慢性腹瀉：一病例報告

Multiple Myeloma Associated with Amyloldosis;Al Type-A Case of Protein Losing Castroenteropathy

賴家明(Jia-Ming Lai) ； 陳靖宙(Gin-Chaw Chen) ； 張繼森(Chi-Sen Chang) ； 陳儉鏗(Gran-Hum Chen)

《中華民國消化系醫學會雜誌》 9卷1期 (1992/03) Pp. 34-36

https://doi.org/10.6557/GJTa.199203_9(1).0006

摘要

一位60歲己婚男性病人，主訴慢性腹瀉半年，最近一個月體重減輕11公斤，經門診入院。小腸X光攝影呈空腸壁增厚；鋇劑大腸造影正常。糞便有潜血反應，血紅素有下降現象，血清白蛋白偏低；胃鏡檢查有胃角部潰瘍，病理報告爲類澱粉蛋白沈著症經剛果紅染色于偏光微鏡下呈蘋果緣反應而證實。十二指腸，迴腸末端及直腸病理切片皆有同樣病烟變化。血蛋白電泳及免疫球蛋白定量分析呈Ig G Kappa chain為主；頭部X光攝影呈多發性骨溶性病變；骨髓檢查亦為多發性骨髓瘤。我們診斷爲與多發性骨髓瘤相關的類澱粉樣蛋白沉著症。

關鍵字

慢性腹鴻 ； 剛果紅染色 ； 胃潰瘍 ； 多發性骨髓瘤

並列摘要

Amyloidosis, AL type has rarely been found clinically. It has poor prognosis and the available treatment modalities are unsatisfactory. It is relatively rare to found in our clinical practices. We reported a case with manifestations of chronic diarrhea, malabsorption and occult gastrointestinal bleeding.
A 60-year-old married male was admitted because of chronic diarrhea for 5-6 months and profound weight loss of 11 kgs in recent one month. Amyloidosis was diagnosed by gastric ulcer biopsy with congo-red staining under polarized microscope. The serum electrophoresis showed a large g'mma globulin peak. The immunoelectrophoresis disclosed a monoclonal kappa chain of IgG. Bone marrow biopsy and aspiration disclosed more than 30% immature plasmocytosis. Punched out lesion in his skull film was found. We diagnosed this case as amyloidosis, AL type, associated with multiple myeloma.

並列關鍵字

chronic diarrhea ； congo-red stain ； multiple myeloma ； gastric ulcer ； gastroentenpathy