Spontaneous pneumoperitoneum: an unusual complication of systemic reactive AA amyloidosis secondary to rheumatoid arthritis

Abstract

We report a 71-year-old man with reactive AA amyloidosis secondaty to rheumatoid arthritis who developed spontaneous pneumoperitoneum with intestinal pseudo-obstruction as an initial symptom. Severe deposition of amyloid in the intestinal wall was considered to play an important role in the pathogenesis of this unusual symptom. The patient has been successfully treated with total parenteral alimentation and intermediate-dose prednisolone (30mg/day). Although pneumoperitoneum usually suggests gastrointestinal perforation requiring emergency surgery, conservative therapy should be seriously considered in amyloidosis-related cases with no associated peritonitis, since multiple vital organs are probably involved by severe amyloid deposition, thus increasing the risks of surgery.

Key Words:

• AA amyloidosis
• spontaneous pneumoperitoneum
• rheumatoid arthritis
• serum amyloid A
• pseudo-obstruction
• gastrointestinal tract
• total parenteral nutrition
• prednisolone