IgA-type myeloma経過中に合併したamyloidosisによるischemic colitisの1例

Transient Type Ischemic Colitis Caused by Amyloidosis Associated with IgA-type Myeloma, Report of a Case

　Ischemic colitisなる疾患概念が，MarstonおよびMarsonらにより1966年に提起されて以来，現在では，そのほかの大腸炎症性疾患と異なる，1つの新しいclinical entityとして広く認められるようになった．われわれも最近IgA typeのmyelomaの臨床経過中に全身性のvascular amyloidosisによるischemic colitisを合併した1例を経験したので，若干の文献的考察を加え報告する．

　A case presented here is of transient type ischemic colitis which was noted to be manifested in a 59 year-old woman, who had been suffering from myeloma for the past six years, and amyloidosis was noted at the present administration. Gastrointestinal diseases associated with amyloidosis have been described by several authors. However, secondary amyloidosis due to myeloma complicated with ischemic colitis has so far not been reported. In this patient a very high concentration of IgA paraproteinemia of 2,540 mg/dl was detected. However, symptoms of hyperviscosity syndrome were not noted. Nearly whole of the transversus colon was affected by the ischemic changes. Endoscopic study revealed multiple superficial transversal and longitudinal ulcerations, erosion and severe edematous change of the colon. However, difference in degree of severity of the changes was observed in the affected colon. Biopsies from different areas revealed deposition of amyloid in the interstitial tissues and in the wall of peripheral arterioles, which obliterated the lumen of the arterioles of the submucosal layer, and from which ischemic changes of the colon were presumed to result.

　She was treated conservatively, and three months after the oneset of the disease, an interesting observation was seen: complete resolution of the ischemic changes observed in most part of the colon with barium and endoscopic studies; however, in some part of the colon slight edematous change and erosion still remained. These endoscopic findings apparently suggest that difference in healing process of the disease exists and the diffenence is confirmed in this case.

　During her hospital life sudden attacks of transient conduction and rhythm disturbance of several variations, such as complete A-V block, or left bundle branch block with idioventricular rhythm have been noted three times. And two months after the discharge she died of the arrhythmia.