P98 | A challenging case of malnutrition

C. Mazzanti¹, A. Fiorentini², S. Mercuri², M. Alberti² | ¹Università La Sapienza di Roma, Dipartimento di Clinica Medica, Roma, ²UOC Medicina Generale, Ospedale Belcolle, Viterbo, Italy

Introduction: Malabsorption as a clinical manifestation of gastrointestinal amyloidosis is a possible consequence.
Case report: A 55-year-old man presented to the emergency room with recurrent anemia, severe hypoglycemia, and episodes of vomiting. He had a history of renal dysfunction, rheumatoid arthritis, arterial hypertension, and postpolio tetraplegia. In June 2018, he had a right hemicolectomy with ileostomy after an abdominal CT revealed ischemic colitis. Histological investigation revealed ischemic hemorrhagic infarction with amyloidosis. In May 2023, because of his continuous severe anemia, he had a bone marrow biopsy, which revealed periosteal soft tissue with amyloid deposits. Upon arrival, the patient appeared dehydrated and with normal vital signs. The blood test revealed acute renal failure, including normal electrolytes, leukocytosis, platelets, and elevated CRP. The main complication reported was severe hypoglycemia caused by prolonged malnutrition in the presence of systemic and gastrointestinal amyloidosis, which was treated with glucose and NPT infusions. The blood test and clinical picture of acute pulmonary subedema indicated a worsening of cardiac contractility, so he underwent an echocardiogram, which revealed septal hypertrophy (SIVd 20 mm and SIVs 21 mm) and posterior wall (PPd 19 mm and PPs 20 mm) with low systolic function indices (EF 25%). After approximately 20 days in the hospital, the patient died from heart failure and multiple organ failure.
Conclusions: The prognosis for patients with systemic amyloidosis is usually poor.