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Case Report

Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis

Hyung-Won Cho, Hye-Kyung Jung, Hyeon-Ju Kang, Yoon-Pyo Lee, Hye-Won Kang, Ki-Nam Shim, Sung-Ae Jung
The Ewha Medical Journal 2014;37(1):52-55. Published online: March 25, 2014

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Hye-Kyung Jung. Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-2874, Fax: 82-2-2655-2874, junghk@ewha.ac.kr
• Received: September 6, 2013   • Accepted: October 18, 2013

Copyright © 2014. Ewha Womans University School of Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Amyloidosis is characterized by extracellular deposition of protein fibrils in one or multiple organs. AA amyloidosis is secondarily occurred to be related with chronic infections or inflammatory diseases. We report a 67-year-old man suffered from secondary AA amyloidosis related with chronic Clostridium difficile colitis after repeated total hip replacement surgery. Infection control is the most important treatment of AA amyloidosis secondary to chronic infection. However, the patient's C. difficile colitis was not controlled well, eventually toxic megacolon with sepsis was developed. Consequently, he had to take total colectomy, but he expired with multi-organ failures. We suggested that early surgical procedure might be one option for intractable C. difficile colitis complicated with secondary amyloidosis.
  • Keywords: Clostridium difficile; Colitis; Toxic megacolon; Amyloidosis
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Fig. 1
Simple abdominal X-ray of consultation day. The film reveals dilatation of colon.
emj-37-52-g001.jpg
Fig. 2
Computed tomography of abdomen-pelvis. It shows edematous wall thickening with layered appearance from transverse colon to rectum with small ascites in pericolic area.
emj-37-52-g002.jpg
Fig. 3
Sigmoidoscopic finding. Sigmoidoscopy shows that normal colonic vasculature is disappeared and multiple erythematous erosions and atrophic changes are noted in colonic mucosa.
emj-37-52-g003.jpg
Fig. 4
Histopathologic fingings. (A) Congo-red stain reveals apple green birefringence in colonic stroma, compatible with amyloidosis (×100). (B) Immunohistochemical stain shows that amyloid A is strongly positive (×40).
emj-37-52-g004.jpg

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      Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis
      Ewha Med J. 2014;37(1):52-55.   Published online March 25, 2014
      DOI: https://doi.org/10.12771/emj.2014.37.1.52
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      Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis
      Ewha Med J. 2014;37(1):52-55.   Published online March 25, 2014
      DOI: https://doi.org/10.12771/emj.2014.37.1.52
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      Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis
      Image Image Image Image
      Fig. 1 Simple abdominal X-ray of consultation day. The film reveals dilatation of colon.
      Fig. 2 Computed tomography of abdomen-pelvis. It shows edematous wall thickening with layered appearance from transverse colon to rectum with small ascites in pericolic area.
      Fig. 3 Sigmoidoscopic finding. Sigmoidoscopy shows that normal colonic vasculature is disappeared and multiple erythematous erosions and atrophic changes are noted in colonic mucosa.
      Fig. 4 Histopathologic fingings. (A) Congo-red stain reveals apple green birefringence in colonic stroma, compatible with amyloidosis (×100). (B) Immunohistochemical stain shows that amyloid A is strongly positive (×40).

      Fig. 1

      Fig. 2

      Fig. 3

      Fig. 4

      Toxic Megacolon Associated with Secondary Amyloidosis: An Unusual Complication of Clostridium difficile Colitis
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